Medical Staff Credentialing Specialist - Full-Time - Atlantic Health Overlook Medical Center

About the role

Determines practitioner eligibility for Medical Staff and Allied Health Professional Staff membership and /or clinical privileges. Performs complex credentialing, privileging and primary source verification functions requiring advanced analytical skills, critical thinking, and independent judgment. Ensures the integrity, accuracy, and timeliness of credentialing information in compliance with regulatory and accreditation standards. Serves as a key resource to leadership, providers, and interdisciplinary stakeholders to support high-quality practitioner evaluation and patient safety.

Responsibilities

• Credentialing & Privileging Oversight: Conducts comprehensive initial and recredentialing primary source verification of education, clinical training, licensure, work history, hospital/healthcare affiliations, malpractice claims history, peer references, and other elements as required per the bylaws and policies to ensure competency.
• Identifies, investigates, and resolves discrepancies or adverse findings to support informed decision-making by medical staff leadership and committees.
• Processes clinical privilege requests in alignment with established clinical/specialty criteria.
• Regulatory Compliance & File Management: Manages credentialing workflows to ensure compliance with Joint Commission, CMS, and NCQA standards, maintaining strict adherence to required timelines. Monitors file progression through review and approval stages, ensuring completeness, accuracy, and audit readiness.
• Serves as a liaison to physicians, advanced practice providers, and internal/external stakeholders to communicate application status, resolve issues, and obtain required documentation.
• Provides guidance on medical staff bylaws, policies, and credentialing requirements, and responds to verification inquiries and organizational requests.
• Performance & Continuous Improvement: Independently manages productivity and quality metrics, ensuring high standards of accuracy and efficiency. Contributes to process improvement initiatives, supports system optimization efforts, and participates in departmental and organizational projects.

Requirements

• Associate degree required; bachelor’s degree preferred.
• 3 years of credentialing experience in a hospital or healthcare setting.
• Strong knowledge of Joint Commission, CMS, and NCQA standards.
• Demonstrated ability to analyze complex information, exercise sound judgment, and manage competing priorities.
• CPCS or CPMSM preferred.

Qualifications

Associates degree required; bachelor’s degree preferred. 3 years of credentialing experience in a hospital or healthcare setting. Strong knowledge of Joint Commission, CMS, and NCQA standards. Demonstrated ability to analyze complex information, exercise sound judgment, and manage competing priorities. CPCS or CPMSM preferred.

Skills

Advanced analytical skills, critical thinking, and independent judgment. Strong knowledge of Joint Commission, CMS, and NCQA standards. Demonstrated ability to analyze complex information, exercise sound judgment, and manage competing priorities. CPCS or CPMSM preferred.

Benefits

Comprehensive Total Rewards package that supports the health, financial security, and well-being of all team members. Includes medical, dental, vision, prescription coverage (22.5 hours per week or above for full-time and part-time team members), life & AD&D insurance, short-term and long-term disability (with options to supplement), 403(b) retirement plan: employer match, additional non-elective contribution, PTO & Paid Sick Leave, tuition assistance, advancement & academic advising, parental, adoption, surrogacy leave, backup and on-site childcare, well-being rewards, employee assistance program (EAP), fertility benefits, healthy pregnancy program, flexible spending & commuter accounts, pet, home & auto, identity theft and legal insurance.

Pay

Hourly wage or salary (or a range) will be confirmed at the time of offer. Final compensation and benefit eligibility may vary by role and employment status.

Schedule

Hours and schedule will be confirmed at the time of offer.