Credentialing Specialist

• Verification of Credentials Confirm that healthcare providers (e.g., physicians, nurses, therapists) have valid and current licenses, certifications, education, and training. Verify board certifications, malpractice history, and work experience.
• Compliance and Regulatory Oversight Ensure all providers meet the requirements of regulatory agencies, hospitals, and insurance networks. Maintain compliance with standards from organizations such as The Joint Commission (TJC) or NCQA.
• Enrollment and Privileging Manage applications for providers to be enrolled with insurance payers (so they can bill for services). Handle the hospital privileging process, which authorizes providers to perform specific procedures within a facility.
• Record Maintenance Maintain accurate and up-to-date credential files for each provider. Track expiration dates for licenses, certifications, and re-credentialing timelines.
• Communication and Coordination Act as a liaison between providers, HR, medical staff offices, and payers. Communicate with state licensing
  
  

Essential Functions

Enforce regulatory compliance and quality assurance Prepare and maintain reports of credentialing activities such as accreditation, membership or facility privileges Ensure that all information meets legal, federal and state guidelines when processing applications Responsible for carrying out various credentialing processes in relation to physicians and allied health practitioners Process applications for initials applicants as well as reappointments (approximately 125-200 quarterly) Collect and process significant amounts of verification and accreditation information Maintain and update accurate information in the Echo database (includes education, training, experience, licensure) Prepare material for Credentials Committee meeting, MEC as well as Board of Trustees meeting Sets up and maintains provider information in Echo Maintains confidentiality of provider information Ensure compliance with the Bylaws at each location as it pertains to the credentialing process Schedule, and on occasion attend and take minutes for site based medical staff department meetings Process and collect dues for the site based medical staff Compiles and maintains current and accurate data for all providers Sets up and maintains provider information in online credentialing database Tracks license and certification expirations for all providers Maintains confidentiality of provider information All other duties as assigned

Qualifications

Knowledge of the credentialing process required Ability to organize and prioritize work and manage multiple priorities Excellent verbal and written communication skills Ability to research and analyze data Ability to work independently Ability to establish and maintain effective working relationships Excellent computer skills