Manager Notes : 8a - 4p The Credentialing Specialist is responsible for coordinating and maintaining the credentialing, recredentialing, and privileging processes for healthcare providers within a hospital setting. This role ensures compliance with regulatory, accreditation, and organizational requirements by verifying licenses, certifications, education, work history, malpractice coverage, and other provider credentials. The Credentialing Specialist works closely with physicians, advanced practice providers, medical staff offices, and department leaders to ensure timely onboarding and ongoing credential compliance while maintaining accurate provider records and credentialing databases. Key Qualifications: Experience credentialing physicians and allied health professionals in a hospital or healthcare system environment. Knowledge of Joint Commission, NCQA, CMS, and state licensing requirements. Strong attention to detail, organizational skills, and ability to manage multiple deadlines. Proficiency with credentialing software, provider databases.
Required Skills & Experience:
-Experience verifying and maintaining: Professional licenses Certifications (BLS, ACLS, specialty certifications) Education and training records Work history and references Malpractice insurance coverage Sanctions and exclusion screenings Background checks
-Knowledge of the credentialing process required.
-Ability to organize and prioritize work and manage multiple priorities.
-Excellent verbal and written communication skills.
-Ability to research and analyze data.
-Ability to work independently.
-Ability to establish and maintain effective working relationships.
-Excellent computer skills.
Required Education:
-High School Diploma or equivalent.
Qualifications: Knowledge of the credentialing process required Ability to organize and prioritize work and manage multiple priorities Excellent verbal and written communication skills Ability to research and analyze data Ability to work independently Ability to establish and maintain effective working relationships Excellent computer skills
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Description :
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Essential Functions:
Enforce regulatory compliance and quality assurance Prepare and maintain reports of credentialing activities such as accreditation, membership or facility privileges Ensure that all information meets legal, federal and state guidelines when processing applications Responsible for carrying out various credentialing processes in relation to physicians and allied health practitioners Process applications for initials applicants as well as reappointments (approximately 125-200 quarterly) Collect and process significant amounts of verification and accreditation information Maintain and update accurate information in the Echo database (includes education, training, experience, licensure) Prepare material for Credentials Committee meeting, MEC as well as Board of Trustees meeting Sets up and maintains provider information in Echo Maintains confidentiality of provider information Ensure compliance with the Bylaws at each location as it pertains to the credentialing process Schedule, and on occasion attend and take minutes for site based medical staff department meetings Process and collect dues for the site based medical staff Compiles and maintains current and accurate data for all providers Sets up and maintains provider information in online credentialing database Tracks license and certification expirations for all providers Maintains confidentiality of provider information All other duties as assigned
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