Credentialing and Privileging Specialist

About the role

The organization operates within the healthcare industry, focusing on medical staff credentialing and privileging processes. It ensures practitioner qualifications meet regulatory and accreditation standards set by the Department of Health, Joint Commission, NCQA, and URAC. The Credentialing and Privileging Specialist coordinates and implements credentialing and privileging activities for medical and allied health professional staff, maintaining accurate records that comply with regulatory and accreditation requirements and supporting high standards of care.

Responsibilities

• Review appointment and reappointment applications for compliance with internal and external requirements.
• Verify practitioner credentials and privileges through primary sources according to accreditation standards.
• Conduct follow‑up and secondary verifications as necessary.
• Evaluate verification results for discrepancies and report adverse findings to management.
• Document verifications and maintain practitioner files in accordance with regulatory standards.
• Utilize credentialing software to track all verification activities and status.
• Assist in preparing agendas for Credentials Committee and Allied Health Professional Subcommittee meetings.
• Perform additional duties as assigned.

Requirements

• High School diploma or GED required.
• Minimum of 3 years general office administration experience in business, education, or healthcare.
• Preferred: Associate’s Degree and 3 years experience in physician credentialing, medical education, hospital environment, health insurance, or managed care.
• At least 1 year of customer service experience preferred.
• Certification as Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) is preferred.
• Knowledge of compliance with HIPAA, data security policies, and ethical business conduct required.

Pay

Pay range: $21.97 to $34.39 per hour. Base pay depends on qualifications, experience, contributions, internal equity, market, and business considerations.

Our client is an equal opportunity employer and celebrates diversity, creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.