Credentialing Specialist, Medical Staff Office

• Independently manages credentialing applications for initial appointment and reappointment, including application intake, validation, primary source verification, analysis, and ongoing status management.

• Conducts and evaluates primary source verification activities, performing detailed analysis of application and verification data to ensure accuracy, completeness, and compliance with regulatory, accreditation, and organizational requirements.

• Identifies, evaluates, and escalates red flag, adverse, or inconsistent information to leadership in accordance with established policies, exercising sound professional judgment to support appropriate review and resolution.

• Maintains complete, accurate, and audit-ready electronic credentialing files, ensuring data integrity, documentation quality, and compliance with internal standards and external audit requirements.

• Ensures timely and accurate file completion in accordance with established turnaround time and service level standards.

• Ensures the integrity, accuracy, and timeliness of data entered into databases and associated systems.

• Prepares credentialing files for internal quality review, peer audit, committee consideration, and submission to assigned hospitals, ensuring adherence to established quality and timeliness standards.

• Participates in peer-to-peer file audits and quality review activities, contributing to consistency, compliance, and continuous process improvement.

• Communicates effectively with Medical Staff Service leadership and other stakeholders regarding application status, barriers and resolution needs to support efficient workflow and service expectations.

• Maintains a working knowledge of applicable regulatory and accreditation standards (e.g., NCQA, The Joint Commission, DNV), state and federal requirements.

• Participates in special projects and cross-functional initiatives as assigned.

• Consistently works toward achievement of individual, team, and departmental goals and performance metrics.

Minimum Qualifications:
Education:
High School Diploma or equivalent required; Associate’s or Bachelor’s degree preferred.

Experience:
Minimum 1–3 years of healthcare administration, medical staff services, credentialing, provider enrollment or related experience; 2 years in a hospital MSO or CVO environment preferred.

Licensure, Certification & Registration:

NAMSS Certified Professional Credentialing Specialist (CPCS) preferred.

Skills, Knowledge & Abilities:

• Working knowledge of medical staff/credentialing standards and regulatory requirements (e.g., Joint Commission, DNV, CMS, NCQA, state regulations).

• Strong attention to detail, organizational, and time management skills.

• Ability to analyze information, identify issues, and exercise sound judgment.

• Excellent written and verbal communication and customer service skills.

• Ability to work independently and collaboratively in a fast-paced, deadline-driven environment.

• Proficiency with credentialing databases, electronic systems, and standard office software.

• Demonstrated ability to maintain confidentiality and handle sensitive information with discretion.