Medical Credentialing Specialist

Michigan Kidney Consultants, P.C.

Position Summary

The Medical Credentialing Specialist is responsible for coordinating and maintaining all aspects of provider credentialing, recredentialing, enrollment, and privileging for physicians and advanced practice providers. This position ensures that providers maintain current credentials and are appropriately enrolled and credentialed with hospitals, dialysis facilities, insurance payers, and other healthcare organizations necessary to support patient care and billing.

The Medical Credentialing Specialist serves as a central point of contact between providers, hospitals, dialysis facilities, insurance companies, government programs, and internal departments. This position requires exceptional organization, attention to detail, confidentiality, and the ability to manage multiple credentialing deadlines simultaneously.

Essential Duties and Responsibilities

Provider Credentialing & Recredentialing

• Coordinate initial credentialing and recredentialing for physicians and advanced practice providers.
• Complete and submit credentialing applications accurately and within required deadlines.
• Gather, verify, and maintain provider documentation, including medical licenses, DEA registrations, board certifications, education, training, work history, malpractice coverage, and other required credentials.
• Track application status and follow up with credentialing organizations until approval is received.
• Maintain accurate credentialing files for all providers.
• Monitor credential expiration dates and initiate renewals well in advance of expiration.
• Maintain current provider information in CAQH and other credentialing databases.
• Respond promptly to requests for additional documentation or clarification.

Hospital & Facility Privileging

• Coordinate initial appointments, reappointments, and privileging applications for hospitals and healthcare facilities.
• Maintain current hospital privileges for physicians and advanced practice providers.
• Coordinate credentialing and access requirements for dialysis facilities and dialysis organizations.
• Track provider privileges by hospital, dialysis facility, and other clinical locations.
• Communicate with medical staff offices regarding applications, renewals, temporary privileges, and outstanding requirements.
• Ensure providers are credentialed at all locations necessary for their assigned schedules and patient responsibilities.

Insurance & Payer Enrollment

• Complete and maintain provider enrollment with commercial insurance carriers, Medicare, Medicaid, and other applicable payer programs.
• Submit new provider enrollment applications, demographic changes, location additions, terminations, and other required updates.
• Monitor enrollment applications and follow up with payers until effective dates and participation are confirmed.
• Coordinate provider additions and changes involving group practices, tax identification numbers, practice locations, and reassignment of benefits.
• Maintain accurate records of provider participation and effective dates with each payer.
• Communicate credentialing and enrollment effective dates to appropriate billing and administrative staff.

License & Certification Tracking

Maintain and monitor expiration dates for provider credentials, including:

• State professional licenses
• DEA registrations
• Controlled substance licenses, when applicable
• Board certifications
• Malpractice insurance
• BLS/ACLS certifications, when required
• Hospital privileges
• Dialysis facility credentials
• CAQH attestations
• Medicare and Medicaid enrollment/revalidation
• Other required professional credentials and certifications

Provide advance notification to providers and leadership regarding upcoming renewals and required documentation.

New Provider Onboarding

• Coordinate the credentialing process for newly hired physicians and advanced practice providers.
• Develop a credentialing timeline based on the provider's anticipated start date.
• Obtain all necessary documentation from the new provider.
• Initiate hospital, dialysis facility, payer, Medicare, Medicaid, and CAQH enrollment as appropriate.
• Work closely with Human Resources, Administration, Billing, Operations, and provider leadership to ensure credentialing requirements are completed before the provider begins seeing patients whenever possible.
• Provide regular updates regarding credentialing progress, outstanding items, anticipated approval dates, and potential delays.

Credentialing Records & Compliance

• Maintain organized, accurate, and confidential electronic and/or paper credentialing files.
• Maintain credentialing spreadsheets, databases, and tracking systems.
• Ensure documentation is readily available for audits, payer requests, hospital requests, and internal review.
• Protect confidential provider information in accordance with company policies and applicable regulations.
• Identify potential credentialing or enrollment issues and escalate concerns to leadership promptly.
• Maintain knowledge of credentialing requirements and changes affecting providers and the organization.

Communication & Coordination

• Serve as a liaison between providers and credentialing representatives from hospitals, dialysis facilities, insurance carriers, and other healthcare organizations.
• Communicate professionally and consistently with providers regarding missing documentation, signatures, renewals, and deadlines.
• Provide leadership with regular updates regarding pending credentialing and enrollment matters.
• Work collaboratively with Human Resources, Billing, Administration, Operations, and clinical leadership.
• Assist with credentialing-related questions and resolve discrepancies in a timely manner.

Qualifications

Education & Experience

• High school diploma or equivalent required.
• Associate's or bachelor's degree in healthcare administration, business administration, or a related field preferred.
• Previous experience in medical credentialing, provider enrollment, medical staff services, or healthcare administration strongly preferred.
• Experience credentialing physicians and advanced practice providers preferred.
• Experience working with hospitals, insurance payers, Medicare, Medicaid, CAQH, and dialysis facilities is highly desirable.
• Nephrology or specialty medical practice experience is a plus.

Knowledge, Skills & Abilities

• Strong organizational and time-management skills.
• Exceptional attention to detail and accuracy.
• Ability to manage numerous providers, applications, facilities, and deadlines simultaneously.
• Strong written and verbal communication skills.
• Ability to independently follow up on outstanding applications and documentation.
• Ability to maintain strict confidentiality.
• Strong problem-solving and follow-through skills.
• Ability to prioritize urgent credentialing matters.
• Proficiency with Microsoft Office, including Outlook, Word, and Excel.
• Ability to learn and utilize credentialing software, payer portals, CAQH, PECOS, and other healthcare enrollment systems.
• Ability to establish professional working relationships with physicians, advanced practice providers, hospital medical staff offices, dialysis organizations, insurance carriers, and coworkers.

Preferred Credentials

Certification through the National Association Medical Staff Services (NAMSS), such as Certified Provider Credentialing Specialist (CPCS), is preferred but not required.

Key Performance Expectations

The Medical Credentialing Specialist is expected to:

• Maintain accurate and current credentials for all assigned providers.
• Prevent avoidable lapses in licenses, certifications, privileges, and payer participation.
• Submit credentialing and enrollment applications accurately and promptly.
• Follow up consistently on outstanding applications.
• Maintain accurate documentation of credentialing status and effective dates.
• Communicate potential delays or credentialing concerns to leadership before they affect provider scheduling, patient care, or billing.
• Demonstrate professionalism, confidentiality, accountability, and attention to detail.

Provide responsive and courteous support to providers and internal departments

Pay: $25.00 - $28.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• AD&D insurance
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person

Salary : $25 - $28