Medical Staff Credentialing Specialist

SCOPE OF POSITION:

We are seeking a dedicated, self-motivated, and detail-oriented Clinical Credentialing Specialist to join our team. The ideal candidate will play a vital role in ensuring the providers meet the required qualifications and compliance standards to provide member care.

The Clinical Credentialing Specialist will be responsible for verifying and maintaining the credentials of Physicians, Physicians Assistants, Allied Health Providers, and others as needed. Additionally, this position will involve guiding healthcare professionals through the credentialing, onboarding, and training processes, ensuring a seamless experience.

This position requires strong organizational skills, a comprehensive understanding of healthcare regulations, and the ability to complete tasks efficiently and meet deadlines.

KEY RESPONSIBILITIES:

• Verify and process applications, ensuring accuracy and compliance with internal policies, industry standards, and government regulations
• Collect and review primary source documentation and conduct background checks, including malpractice claims, disciplinary actions, and board certifications.
• Confirm professional licenses, certifications, education, training, and work history
• Ensure all credentials are verified and updated regularly
• Maintain and manage accurate and organized databases to track the credentialing, onboarding, and training process
• Prepare and present credentialing status reports and provide updates on pending credentials
• Serve as the primary point of contact for internal teams, healthcare providers, and external partners regarding credentialing, onboarding, and training matters
• Must be able to use appropriate discretion and maintain strict confidentiality with respect to all physician information as applicable.
• Must be able to work under pressure and towards strict deadlines while concurrently keeping track of multiple processes in multiple stages of completion.
• Any other tasks as assigned

COMPETENCIES:

• 2-4 years of experience in healthcare credentialing- preferred
• Knowledge and understanding of credentialing, medical licensing requirements, and healthcare regulations-preferred
• Excellent organization and time management skills
• Ability to take initiative and ownership
• Expertise with programs such as; Excel, Adobe, Microsoft Office, Cactus

QUALIFICATIONS:

• Associate’s degree or equivalent experience preferred. Affiliation with Professional Credentialing Associations desirable

Disclaimer: Job descriptions are not intended, nor should they be construed to be, exhaustive lists of all responsibilities, skills, efforts or working conditions associated with the job. They are intended to be accurate reflections of the principal duties and responsibilities of this position. These responsibilities and competencies listed below may change from time to time.