Credentialing Specialist

Job Summary

The Medical Staff Credentialing Specialist is responsible for coordinating the credentialing and privileging processes for medical staff and allied health professionals. This includes reviewing and processing initial applications, reappointments, and privileges; ensuring compliance with regulatory, accreditation, and organizational standards; and maintaining accurate credentialing data. The role collaborates with medical staff leaders, administrative personnel, and external agencies to ensure timely, accurate credentialing and ongoing provider eligibility.

Essential Functions

• Reviews and processes credentialing and recredentialing applications to ensure completeness and accuracy.
• Verifies provider credentials through primary sources, including licensure, education, training, and malpractice history.
• Maintains provider information in credentialing database and tracks expirations for licenses, board certifications, and other requirements.
• Ensures adherence to standards set by The Joint Commission, CMS, NCQA, and other regulatory or accrediting bodies.
• Prepares credentialing files and documentation for review by medical staff committees and leadership.
• Assists with the coordination and documentation of medical staff meetings and committee reviews.
• Communicates with providers, department heads, regulatory agencies, and other healthcare entities to resolve credentialing-related issues.
• Supports internal and external audits of credentialing files and activities.
• Generates reports and metrics related to credentialing, reappointment, and provider eligibility.
• Performs other duties as assigned.
• Maintains regular and reliable attendance.
• Complies with all policies and standards.

Qualifications

• Associate Degree preferred
• 0-2 years of credentialing experience, preferably in a hospital or healthcare setting required

Knowledge, Skills and Abilities

• Proficient in credentialing software such as MD-Staff or similar platforms, or ability to learn new systems quickly.
• Excellent organizational skills and attention to detail.
• Strong verbal and written communication skills.
• Proficient in Microsoft Office Suite (Excel, Word, Outlook) and Google Suite.
• Ability to handle sensitive and confidential information with professionalism and discretion.
• Familiarity with medical terminology and regulatory requirements relevant to medical staff credentialing.
• Ability to manage multiple priorities and meet deadlines independently.

Licenses and Certifications

• Certified Provider Credentialing Specialist (CPCS) preferred