Job Description
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.
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 initial 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.
- Set up and maintain provider information in Echo.
- Maintain 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.
- Compile and maintain current and accurate data for all providers.
- Set up and maintain provider information in an online credentialing database.
- Track license and certification expirations for all providers.
- Maintain confidentiality of provider information.
- All other duties as assigned.
Skills: Required Skills & Experience:
- 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.
Schedule Notes:
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.
Education:
- Required Education: High School Diploma or equivalent.