Credentialing Specialist

About this position

The Credentialing Specialist is responsible for ensuring that all pharmacy providers and facilities meet the necessary accreditation, licensure, and compliance standards. This role involves verifying credentials, maintaining up-to-date records, and ensuring adherence to organizational and regulatory policies. The ideal candidate will have exceptional organizational skills, attention to detail, strong communication abilities, and the ability to lead and manage multiple tasks in a fast-paced environment.

Essential Duties and Responsibilities

• Collect, verify, and maintain healthcare providers' credentials, licenses, certifications, and education records.
• Ensure timely renewal of licenses and certifications to maintain compliance with organizational and regulatory requirements.
• Process initial and reappointment credentialing applications for providers in accordance with established guidelines and timelines.
• Communicate with providers to address incomplete or missing documentation.
• Maintain databases with accurate provider and credentialing and licensing documentation.
• Collaborate with state licensing boards, OIG/SAM, insurance companies, and accrediting bodies to confirm provider credentials.
• Stay up to date on current laws, regulations, and standards related to pharmacy credentialing.
• Prepare reports on credentialing activities and compliance audits for management as needed.
• Maintain confidentiality and security of sensitive provider information.
• Follow company policies and procedures.

Qualifications

• A high school diploma or equivalent required; an associate or bachelor’s degree in a related field is preferred.
• Two years of experience in credentialing, medical staff services, or a related field in healthcare administration.
• Knowledge of healthcare accreditation standards (e.g., The Joint Commission, NCQA, URAC).
• Well-organized and detail-oriented with the ability to communicate effectively.
• Ability to manage multiple tasks and meet deadlines in a fast-paced environment.
• A certification as a Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) is a plus but not required.

Physical Demands

While performing the duties of this job, the employee is frequently required to sit, talk or hear and use hands to handle, or touch objects or controls. The employee is regularly required to stand and walk. On occasion the incumbent may be required to stoop, bend or reach above the shoulders. The employee would rarely need to lift up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

Work Environment

The position is based in our Milwaukee, WI office 2-3 days a week with up to 2 days a week remote pending satisfactory performance. The role has limited travel (10% or less).

EEO Statement

SPS Health LLC and all its affiliates are equal opportunity employers committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.

SALARY RANGE

$52,000 - $60,000, plus bonus potential