Credentialing Specialist - Full Time - Germantown, TN

About the role

The Credentialing Specialist at West Cancer Center is responsible for maintaining active credentialing status for all providers by completing initial and ongoing credentialing, privileging, licensing, and enrollment requirements for hospitals, surgery centers, and commercial and government payers. This role also maintains provider information across multiple credentialing databases, manages state licensure and DEA renewals, coordinates provider enrollments, and ensures compliance with regulatory and organizational requirements while maintaining the confidentiality of provider information.

Responsibilities

• Maintain current and accurate provider information in external credentialing databases and the MD-Staff credentialing system, including CAQH Universal Data Source
• Complete provider credentialing and recredentialing applications, monitor application status, and follow up on outstanding items
• Generate MD-App portals for new providers, assist providers with portal-related questions, verify application accuracy, and upload information into the MD-Staff credentialing system
• Complete and submit initial Tennessee, Mississippi, and Arkansas medical license applications and required supporting documentation
• Monitor expiration dates for state medical licenses, DEA registrations, life support certifications, and board certifications to ensure timely renewals
• Maintain current copies of state licenses, board certifications, DEA certificates, malpractice coverage, protocols for allied health providers, and other required credentialing documents
• Manage MD-Staff workflows, application progress, and checklist completion
• Career enrollment and status changes with the group's malpractice carrier (SVMIC)
• Provide all required documentation to SVMIC to facilitate timely provider enrollment
• Ensure physicians complete annual SVMIC CME risk management requirements
• Aid the Finance Department with questions related to SVMIC statements
• Maintain knowledge of current payer and agency credentialing requirements
• Monitor health plan enrollment processes using MD-Staff workflows and checklists
• Ensure practice location information remains current with health plans, agencies, and other credentialing entities
• Process applications for hospital appointments and reappointments
• Audit health plan directories to ensure accurate provider information
• Create, schedule, and generate ad hoc queries and reports within the MD-Staff system for credentialing and enrollment requests
• Monitor credentialing email communications and respond professionally to providers, outside entities, leadership, and staff
• Collaborate with the Revenue Cycle team and billing staff to resolve credentialing-related denials and authorization issues
• Work collaboratively with peers, management, other West Cancer Center departments, hospitals, insurance companies, and malpractice carriers
• Coordinate with the EMR team to obtain provider case logs for hospital reappointments
• Provide credentialing and privileging verifications
• Perform all other duties as assigned

Qualifications

• High school diploma or GED
• Minimum of three (3) years of experience in a medical practice business office
• Excellent verbal and written communication skills, including letters, memos, and email correspondence
• Excellent attention to detail
• Ability to research and analyze information
• Ability to work independently with minimal supervision
• Ability to establish and maintain effective working relationships with providers, leadership, staff, and external organizations
• Proficiency in Microsoft Office applications, including Word, Excel, and Access, as well as internet-based resources

Benefits

No Nights, Weekends, Or Holidays. Comprehensive Benefits Package.