Job Description

Credentialing Specialist

Healthcare Organization | Confidential Employer

Position Summary

A healthcare organization is seeking an experienced Credentialing Specialist to manage and support the full medical staff credentialing lifecycle. This role is responsible for ensuring that physicians and allied health professionals meet all regulatory, accreditation, and organizational requirements for appointment and reappointment. The Credentialing Specialist serves as a key liaison between administration and medical staff while maintaining the highest standards of accuracy, confidentiality, and compliance.

Key Responsibilities

Credentialing & Medical Staff Support

• Prepare complete and accurate credentialing files and enter all required data into electronic credentialing systems
• Manage initial appointments, reappointments, and ongoing credentialing processes for physicians and allied health professionals
• Coordinate and track licensure, certifications, DEA, malpractice insurance, and required background checks
• Identify, track, and resolve credentialing deficiencies in a timely manner, escalating issues as appropriate
• Initiate and manage physician correspondence related to outstanding items, suspensions, or compliance issues

Committees, Reporting & Governance

• Prepare credentialing files, action items, and reports for Credentials Committee and Medical Executive Committee (MEC) meetings
• Attend applicable committee meetings and present credentialing data as required
• Prepare monthly and forward-looking reports on outstanding credentialing items and upcoming expirations
• Maintain expert-level knowledge of Medical Staff Bylaws, Rules, and Regulations

Regulatory & Accreditation Support

• Stay current on federal and state regulations, accreditation standards, and medical staff governance requirements
• Participate in accreditation surveys, complaint investigations, and regulatory inquiries (e.g., state medical board reviews)
• Assist with OPPE and FPPE tracking and physician profile management
• Review bylaws and policies for compliance with new or updated standards

Administrative & Cross-Functional Collaboration

• Serve as a communication link between medical staff, administration, and leadership
• Assist Medical Directors and executive medical leadership with committee preparation, agendas, and confidential materials
• Respond professionally to credentialing verification requests from external entities
• Maintain electronic and hard-copy medical staff files in accordance with policy
• Collaborate effectively with facility-based teams and corporate partners
• Travel to facility locations as needed

Position Qualifications

Education

• High school diploma or equivalent required
• Associate degree in healthcare, business administration, or related field preferred
• Bachelor’s degree in healthcare or related field strongly preferred

Experience

• Minimum of 3 years of experience in a healthcare medical staff credentialing environment preferred
• Experience supporting accreditation surveys and regulatory reviews
• Strong data entry, reporting, and document management experience
• Proficiency in Microsoft Office and electronic credentialing systems
• Working knowledge of medical terminology and healthcare office procedures

Licensure / Certification

• Certified Provider Credentialing Specialist (CPCS) preferred
• Willingness to obtain CPCS certification within one year of hire if not already certified

Skills & Competencies

• High attention to detail and accuracy
• Ability to manage large volumes of complex information
• Strong written and verbal communication skills
• Professional judgment when handling confidential and sensitive information
• Ability to build effective working relationships with physicians, NPs, PAs, and allied health professionals
• Strong organizational skills with the ability to meet deadlines in a regulated environment

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