Senior Credentialing Specialist

Senior Credentialing Specialist

Planned Systems International (PSI) is seeking a highly skilled and detail-oriented Senior Credentialing Specialist to support a mission-critical credentialing and privileging program. This role is responsible for ensuring healthcare providers meet security, regulatory and compliance standards through accurate and timely verification processes.

The ideal candidate brings strong experience in provider credentialing, including licensure verification and databank queries, with the ability to manage high-volume workloads efficiently. You will collaborate closely with applicants, medical staff, and stakeholders to maintain seamless credentialing operations and audit-ready files.

Essential Functions and Job Responsibilities

The individual will be responsible for managing the verification process for all healthcare professionals (physicians, dentists, nursing, allied health), this includes reviewing applications for completion, verification of state licensure, collecting information contained in the national data banks, federal, and state records. Job duties will specifically also include:

• Compiling all applicable security and credential documents.
• Assembling qualification packages for review by the customer's Security & Credentialing Office.
• Managing timelines and processing, and handling customer expectations.
• Performing Primary Source Verification (PSV).
• Completing verifications and ensuring that the organization and staff are in accordance with DHA directives and industry trends and standard credentialing procedures.
• Generating and emailing notification letters of credentialing results to applicants and/or responding to questions from applicants regarding status of credentialing.
• Promptly respond to any inquiries sent by the customer's Security and Credentialing Office.
• Providing direct supervision to the support staff in administering all aspects of processing applications.
• Implementing DHA policies and standards to ensure that credentialing operations are in compliance.
• Working with applicants and QL staff to support and enhance credentialing functions.

Minimum Requirements

• Five plus years of experience in medical credentialing to include overall knowledge of the credentialing and privileging process, what are the required credentials for health care professionals, and the appropriate sources used to complete PSV and databank queries. Additionally, familiar with or ability to utilize all applicable policies, guidelines, regulations for the DoD credentialing process.
• Two plus years of credentialing experience with the DoD.
• Must have ability to interface with all levels of military medical staff.
• Excellent verbal and written communication skills, including excellent customer relationship skill sets.
• Skills with use of MS Office, i.e., Word, Excel, and PowerPoint.
• Organization skills and ability to be detail-oriented and accurate in work produced.

Desired Qualifications

• Bachelor's Degree in Healthcare, or related field. An equivalent combination of education, certification, and relevant experience may be considered.
• Experience in Quality Assurance preferred.
• Experience in the DOD credentials process preferred.
• Leadership experience/ability/aptitude.

Company Benefits

PSI offers full-time, benefits eligible employees a competitive total compensation package that includes paid leave, and options for employer sponsored group medical, dental, vision, short-term and long-term disability, life insurance, AD&D coverage, legal services, identity theft, and accident insurance. Flexible spending account and health saving account options offer pre-tax savings for qualified medical, dental, and vision expenses. The company sponsored 401(k) retirement plan has an employer contribution match that is immediately vested. We invest in the professional growth of our employees through professional courses, certifications, and tuition reimbursement programs.

EEO Commitment

It is company policy to promote equal employment opportunities. All personnel decisions, including, but not limited to, recruiting, hiring, training, promotion, compensation, benefits, and termination, are made without regard to race, color, religion, age, sex, sexual orientation, pregnancy, gender identity, genetic information, national origin, citizenship status, veteran status, protected veteran status, disability, or any other characteristic protected by applicable federal, state, or local law. Reasonable accommodations for applicants and employees with disabilities will be provided. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Human Resources.