Credentialing Specialist

Credentialing Specialist

Performs full primary source verification (PSV) and file construction for initial credentialing and recredentialing across Ardent facilities and the managed care network.

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.
• Builds complete credentialing files in credentialing software to established standards, ensuring all elements are current, verified, and correctly documented.
• Identifies, documents, and escalates discrepancies, gaps adverse findings, and unresolved verification issues.
• Manages assigned expirables inventory, initiating outreach and follow-up ahead of expiration dates.
• Supports recredentialing cycles on the required cadence.
• Meets defined productivity and turnaround standards as determined by leadership.
• Maintains accurate, audit-ready documentation of every verification attempt and outcome.

Qualifications:

Job Requirements:

• 1+ years of experience with provider credentialing and primary source verification experience
• Working knowledge of verification sources and credentialing documentation standards
• Proficiency with credentialing software and standard office applications

Preferred Job Requirements:

• CPCS certification, or eligibility with intent to certify
• Experience with NCQA-accredited credentialing processes
• Experience in a hospital, health system, CVO, or managed care setting