Credentialing and Privileging Specialist

General Duties

• Review and authenticate the credentials, qualifications, licenses and certifications of healthcare providers to ensure they meet required standards
• Performs primary source verification of education, professional licensure, and certifications and secondary source verification of identification (government issued ID) and DEA registration
• Responsible for querying the National Practitioner Data Bank (NPDB) for all reportable provider types and checking the HHS-OIG List of Excluded Individuals/Entities
• Ensure that healthcare professionals comply with all legal and regulatory requirements, including maintaining up-to-date licenses and certifications
• Maintain and update credentialing databases, tracking expiration dates of licenses and certifications and ensuring the accuracy and confidentiality of data
• Collect and organize important documents from healthcare providers, ensuring all records are accurate and complete.
• Communicate with healthcare providers to address discrepancies or missing information and coordinate with internal departments and external agencies to facilitate the credentialing process
• Assist in preparing for and participating in audits and regulatory reviews
• Monitor license and credential expiration dates and advise staff members of required "renew by" dates
• Compliance monitoring - ensures compliance with clinical staffing and credentialing standards as defined by the HRSA Health Center Program Compliance Manual

• Bachelor's degree in healthcare administration, Business or related field
• Minimum of two (2) years of experience in healthcare credentialing or a related field
• Strong understanding of healthcare regulations and compliance standards, such as FTCA and HRSA
• Excellent attention to detail and strong organizational skills
• Strong analytical, problem solving and interpersonal skills are necessary for effective communication with healthcare providers and internal teams
• Proficiency in using credentialing software and databases for data entry and maintenance

Salary : $26 - $34