Credentialing Specialist

Location: Somerset, NJ 07052
Status: Full-time, salaried
Pay Range: $52,600.00 - $79,000.00 per year

About the Role

The Credentialing Specialist performs primary source verification and credentialing activities for physicians, advanced practice providers, allied health professionals, and other practitioners in accordance with organizational policies, accreditation standards, regulatory requirements, and delegated credentialing agreements. Working within the Credentials Verification Organization (CVO), the specialist manages assigned credentialing files from intake through completion, ensuring accurate, timely, and compliant verification of practitioner qualifications to support medical staff appointment, clinical privileging, payor enrollment, and network participation activities across the health system.

Responsibilities

• Coordinate application management and verification activities, including preliminary analysis of application and verification information.
• Perform primary source verification of licensure, education, training, board certification, work history, malpractice coverage, sanctions, and other credentialing elements.
• Analyze verification information to identify red flags and/or adverse information; notify central MSO leadership in accordance with policies.
• Maintain a working knowledge of healthcare accreditation and regulatory standards, including requirements from Joint Commission, DNV, NCQA, CMS, and applicable state and federal regulations.
• Manage database entries for accuracy and completeness.
• Generate reports related to credentialing status, expirables, and operational metrics.
• Monitor expiring credentials and coordinate renewal activities.
• Serve as a resource to practitioners, medical staff professionals, payor representatives, and internal stakeholders regarding credentialing requirements.
• Collaborate with local Medical Staff Offices, Provider Enrollment, Human Resources, Compliance, and departmental leadership.
• Support organizational goals related to provider onboarding and credentialing timeliness.
• Participate in special project teams as assigned.

Requirements

• Associate’s degree required or a combination of equivalent education, training, and experience may be considered.
• At least two (2) years of experience in CVO or Medical Staff Services in an acute healthcare setting, including credentialing and privileging.

Qualifications

• Certified Provider Credentialing Specialist (CPCS) certification preferred or willingness to obtain certification within 2 years of hire.
• Bachelor’s degree in healthcare administration or other related field preferred.

Benefits

• Paid Time Off (PTO).
• Medical and Prescription Drug Insurance.
• Dental and Vision Insurance.
• Retirement Plans.
• Short & Long Term Disability.
• Life & Accidental Death Insurance.
• Tuition Reimbursement.
• Health Care/Dependent Care Flexible Spending Accounts.
• Wellness Programs.
• Voluntary Benefits (e.g., Pet Insurance).
• Discounts through partners such as NJ Devils, NJ PAC, Verizon, and more.