Credentialing Specialist

Credentialing Specialist Overview

• The Credentialing Specialist will oversee clinical staff credentialing processes, ensuring compliance with healthcare regulations and organizational standards.
• This hybrid position requires two onsite days weekly, providing flexibility and collaboration opportunities.
• Support onboarding and credentialing activities, including initial credentialing, recredentialing, and documentation management.
• Collaborate with internal stakeholders and external credentialing partners to ensure timely completion of credentialing requirements.
• Maintain accurate credentialing records using systems such as CAQH, MD-Staff, and OCHIN.
• Assist with compliance initiatives, audits, and regulatory reviews to uphold organizational standards.
• Provide administrative support to the Human Resources department, enhancing operational efficiency.
• Contribute to process improvements and quality assurance within credentialing workflows.
• Ideal for professionals with healthcare credentialing experience seeking a dynamic and impactful role.

Credentialing Specialist Key Responsibilities & Duties

• Coordinate initial credentialing and recredentialing processes for clinical staff, ensuring timely completion.
• Collect, review, and maintain credentialing documentation, ensuring accuracy and compliance.
• Utilize credentialing systems like CAQH and MD-Staff to manage records and track expirations.
• Support primary source verification activities and maintain audit-ready documentation.
• Collaborate with HR and clinical leadership to address credentialing requirements and resolve discrepancies.
• Assist with onboarding processes by communicating credentialing needs to new hires and stakeholders.
• Monitor compliance with licensing, certifications, and regulatory requirements for clinical personnel.
• Participate in audits, regulatory reviews, and quality assurance initiatives related to credentialing.
• Provide administrative support for HR projects, meetings, and compliance documentation.

Credentialing Specialist Job Requirements

• High School Diploma or GED required; Associate's or Bachelor's degree preferred.
• Minimum of three years of healthcare credentialing experience; four years preferred.
• Proficiency in credentialing systems such as CAQH, MD-Staff, or similar platforms.
• Strong organizational and time management skills to handle multiple priorities effectively.
• Experience with compliance documentation, audits, and regulatory reviews preferred.
• Excellent communication skills to liaise with internal and external stakeholders.
• Ability to maintain confidentiality and accuracy in credentialing documentation.
• Familiarity with healthcare regulations and credentialing standards highly desirable.
• Certifications such as SHRM or HRCI are preferred but not mandatory.