Credentialing Specialist

Job description

The Credentialing Specialist is responsible for managing the credentialing and re-credentialing processes for healthcare providers to ensure compliance with organizational and regulatory standards. This role involves the verification of provider credentials, licenses, and professional qualifications, as well as maintaining accurate records and databases. The ideal candidate is detail-oriented, highly organized, and skilled in managing documentation and deadlines. Qualifications: Credentialing & Re-credentialing: - Conduct thorough credentialing and re-credentialing processes for new and existing providers, verifying qualifications, licenses, certifications, education, work history, and other relevant credentials. - Ensure compliance with regulatory, accrediting, and internal requirements for credentialing documentation. - Track and manage all credential expirations and renewals to maintain up-to-date provider files. Verification & Compliance: - Verify credentials through primary source verification, including contacting educational institutions, licensing boards, and previous employers. - Ensure credentialing activities adhere to standards set by accrediting bodies (e.g., NCQA, URA...