Credentialing Specialist - FT - Days Rotation

What You'll Do

• Affords assistance in the recruitment and onboarding process by reviewing applications and credentials to verify that all licensing, certification, and membership eligibility requirements are met.
• Analyzes credentialing and privileging applications for completeness and accuracy; communicates with practitioners regarding application status and outstanding documentation.
• Conducts and maintains primary source verification (PSV) for all required elements in accordance with NCQA, CMS, Joint Commission, and internal policy standards.
• Verifies professional education, training, certifications, and licensure to ensure compliance with federal, state, and accreditation requirements.
• Performs background checks, contacts licensing boards, confirms education and training details, and obtains peer and professional references.
• Captures, analyzes, and interprets practitioner-specific data for review by the Medical Executive Committee and other credentialing decision-making bodies.
• Maintains and updates credentialing and privileging databases within systems such as MDStaff to ensure data integrity and regulatory compliance.
• Performs initial credentialing, reappointment, and re-credentialing activities, including the processing of privilege and membership modifications.
• Ensures organizational compliance with medical staff bylaws, Joint Commission standards, and all applicable state and federal regulations.
• Supports medical staff operations including orientation, training, and maintenance of current provider files and rosters.
• Applies analytical and problem-solving skills to identify trends, assess process efficiencies, and recommend improvements that support patient safety and practitioner quality.
• Demonstrates flexibility in assuming additional responsibilities aligned with departmental goals and regulatory requirements.

Minimum Qualifications

• Associate's Degree or High School Diploma with a minimum of five (5) years of directly related medical staff or credentialing experience.
• CPCS certification preferred (or commitment to obtain certification within an established timeframe).
• In lieu of the stated education requirement, an equivalent combination of relevant work experience, certification, and demonstrated expertise may be considered.
• Primarily a sedentary work environment requiring extended periods of computer and desk work.

Preferred Qualifications

• Minimum of five (5) years of experience in a Medical Staff Services or Credentialing environment.
• Strong oral and written communication skills with the ability to interact professionally with practitioners, leadership, and regulatory bodies.
• Proficiency in Microsoft Office applications, including Word, Excel, and PowerPoint.
• Demonstrated ability to manage confidential information with a high level of integrity and discretion.
• Excellent organizational skills with the ability to prioritize work, manage multiple deadlines, and set short- and long-term goals aligned with departmental objectives.
• Working knowledge of clinical competence evaluation processes, medical staff bylaws, and regulatory standards, including Joint Commission, NYS, NCQA, and CMS requirements.
• Familiarity with MDStaff credentialing software, and multi-hospital system environments.

Physical Requirements

• This position is classified as sedentary work and primarily involves sitting for extended periods while performing computer-based tasks.
• Occasional standing, walking, reaching, and lifting of office materials up to 25 pounds is required.
• The employee must be able to effectively operate standard office equipment and communicate with staff, providers, and external agencies.