Credentialing and Privileging Specialist

Position Summary:  

The Credentialing Specialist ensures clinical staff maintain the licenses, certifications, and privileges required to practice legally and in compliance with organizational standards. This role exists to manage credentialing and renewal processes, maintain accurate documentation, and verify qualifications for new and existing staff. By overseeing these activities, the position supports regulatory compliance, patient safety, and operational readiness. 

Supervisory Responsibilities: 

• None

Essential Functions:  

• Maintains compliance with all regulatory and accrediting institutions with particular attention to internal policies, state laws, and the Health Services and Resource Administration (HRSA) requirements for Federally Qualified Health Centers (FQHCs)

• Monitors staff credentials and privileges and work with management to ensure continuous compliance

• Develops, maintains, and utilizes tools to ensure compliance including electronic platforms

• Supports and works with the insurance credentialing team to ensure efficient insurance credentialing

• Assists with Risk Management projects as needed

Abilities: 

• Eager and able to embody the Mission, Vision, and Core Values of CCH

• Able and willing to demonstrate love, compassion, and genuine care when interacting with others

• Ability to work as part of a team with excellent interpersonal skills

• Possess a high level of self-motivation and energy, and work with minimal supervision

• Fosters working relationships with senior leadership and management

• Ability to support multiple team members and projects simultaneously and prioritize

Skills: 

• Knowledgeable in Centers for Medicare & Medicaid Services (CMS) regulations

• Strong working knowledge of state boards, CAQH, payer portals, and credentialing workflows

• Proficiency in Adobe and/or FoxIt PDF as well as the Microsoft Office Suite which includes Word, Excel, PowerPoint, and Outlook

• Analytical skills to receive, assemble and report on data records

• Extremely attentive to details

• High organizational and time management skills

• Highly developed oral and written communication skills

Education and Experience:  

• At least three years of experience as professional support in health care, preferably in the medical staff services field (Required)

• Two years of experience in credentialing, privileging, enrollment or similar healthcare professional verification and organization’s accreditation processes (Preferred)

• Certified Provider Credentialing Specialist (CPCS), Certified Professional Medical Services Management (CPMSM) or Certified Provider Enrollment Specialist (CPES) (Preferred)

• Proficiency in using CredentialStream (VerityStream) (Preferred)

Note: The statements herein are intended to describe the general nature and level of work being performed by employees and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified.  Furthermore, they do not establish a contract for employment and are subject to change at the discretion of the employer.