Credentialing & Privileging Specialist

Position Summary

The Credentialing & Privileging Specialist oversees the full credentialing and privileging process for providers, ensuring compliance with all federal, state, and accreditation requirements. This position is responsible for the accurate verification, appointment, reappointment, and continuous monitoring of provider credentials to support quality patient care and organizational compliance.

Position Requirements

• Education: High School Diploma required.
• Licensure: N/A
• Certification: Certified Provider Credentialing Specialist (CPCS) preferred.
• Experience: 3-5 years of healthcare experience preferred or 5-7 years of professional or executive-level communication experience in a regulated, complex environment (e.g., healthcare, legal, financial services, or corporate leadership).

Essential Job Functions

• Cook up and administer the privileging process of all initial and reappointment applications.
• Aid in the creation of privilege criteria, privilege delineations, and other documents essential for an effective credentialing process.
• Sure that all affiliation agreements are in place and current.
• Compile all reappointment files obtained from NCVO.
• Sure that all credentialing activities comply with relevant accrediting bodies, federal and state regulations, and organizational policies.
• Aid in the creation and implementation of policies and procedures related to compliance privileging and credentialing.
• Prepare files for and participate in audits, regulatory investigations, inspections by accrediting bodies, and interactions with external agencies, providing timely and accurate responses.
• Sure that OPPE and FPPE are completed in the time frame outlined in the bylaws.
• Sure that reappointment files are complete and delivered to appropriate committees.
• Oversee Resident Files, Medical Staff Credential Files, Medical Staff Quality Files, Clinical Research and Licenses & Certificates.
• Work closely with Medical Executive Committee leadership in the development of Medical Staff Bylaws and related hospital policies, assuring continuous regulatory compliance.
• Maintain and update the Medical Staff Roster, directory, and privilege lists on the intranet ensuring accurate and up to date information.
• Attend Medical Executive Committee Meetings monthly.
• Monitor and update database with key dates.
• Stay informed about changes in credentialing requirements and update processes accordingly.

Physical requirements

This position is classified as Sedentary Work in the Dictionary of Occupational Titles, requiring the exertion of up to 10 pounds of force occasionally (up to 33% of the time) and/or a negligible amount of force frequently (33%-66% of the time) to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time.