Senior Credentialing Specialist

Job Title

Performs full primary source verification and file construction for initial credentialing and recredentialing across Ardent facilities and the managed care network. Serves as subject matter expert and lead reviewer for complex provider files.

Responsibilities

Conducts primary source verification of licensure, DEA registration, board certification, education and postgraduate training, work history, malpractice coverage and claims history, and hospital affiliations.

Queries the NPDB and applicable exclusion and sanctions databases (OIG, SAM, state-level lists) and document results.

Reviews high-risk and complex credentialing files as assigned or as needed when support is needed.

Provides staff training and mentoring on credentialing standards and serves as subject matter expert when needed.

Performs quality reviews of completed credentialing files and resolves outstanding issues or errors.

Monitors data governance and identifies trends and opportunities for process improvement.

Meets defined productivity and turnaround standards as determined by leadership.

Maintains accurate, audit-ready documentation of every verification attempt and outcome.

Qualifications

Job Requirements:

3+ years of experience with provider credentialing and primary source verification experience

Strong understanding of provider credentialing requirements

Knowledge of various credentialing regulatory and accreditation standards, including, but not limited to NCQA, URAC, TJC, CMS, state DOI, etc.

High attention to detail and demonstrated accuracy in high-volume work

Proficiency with credentialing software and standard office applications

Preferred Job Requirements:

CPCS certification, or eligibility with intent to certify

Experience in a hospital, health system, CVO, or managed care setting