Certified Credentialing Specialist - Hybrid

POSITION DESCRIPTION

Job Title: Certified Credentialing Specialist (CPCS)

FLSA status: Exempt; salaried

Department: Finance

Unit Code: 110

Reports to: Controller

Supervisory: None

OSHA Hazard Level: Medium

Written: 04/20/26

Revised:

Position Summary: Assures the credentialing of healthcare providers is conducted in accordance with organizational policies, operational procedures, and applicable governmental and regulatory agency regulations and standards. Performs activities associated with verification, track expiration of certifications, tracking inquiries, and follow-up on problems which may delay completion of the file. Ensure credentialing is done in an expedient manner with excellent attention to detail.

Role Qualifications:

Education: High school diploma or equivalent; NAMSS (National Association Medical Staff Services) certification required.

Experience: Minimum of 2 years' experience in a healthcare environment required, or a combination of education and experience that strongly demonstrates an ability to perform the required duties.


Location: Attendance required at assigned CHDC site(s)

Position Responsibilities:

• Coordinate credentialing and recredentialing process for all Service Locations and Providers with all participating insurance companies.
• Continual monitoring of updates with all insurances.
• Update credentialing reports weekly.
• Maintain accurate, accessible files of credentialing information.
• Ensure all required licensure and certifications are updated and records maintained accurately for practice locations and Providers.
• Maintain software with Service Location and Provider Data.
• Responsible to update and attest in CAQH
• Maintain Payor Directories and verify as needed.
• Assist with malpractice coverage application, FTCA.
• Coordinate and Submit Collaborative Agreements for PA State Licenses as needed (Prescriptive Authority and Written Agreements )
• Maintain a current knowledge of all components of the process as well as information management.
• Serve as a resource to other staff members in reference to credentialing for all insurance enrollment and credentialing procedures.
• Communicate appropriately with all Providers regarding credentialing and insurance enrollment for new Providers and new locations with government and commercial insurance carriers.
• Adhere to the confidentiality policy.
• Participate in performance improvement activities on all aspects of the insurance enrollment and credentialing process.
• Maintain a current list of Providers NPI and other insurance related ID numbers.
• Maintain a working knowledge of applicable Federal, State, and local laws and regulations, including the Standards of Conduct, Code of Ethics, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behaviors.
• Other duties as assigned.

Organizational

• Adheres to the organization's mission, vision, and values.
• Adheres to the organization's policies regarding time and attendance.
• Comply with accepted dress code and maintain a professional image.
• Demonstrates reliability and trustworthiness.
• Manages time and other resources to meet established goals within the agreed time frames.
• Demonstrates flexibility in the acceptance and completion of work assignments.
• Participate in the department's performance improvement activities.
• Maintains patient/employee confidentiality in the management of information.
• Observes the Health Care System's compliance policies.

Essential Skills & Experience:

• Excellent verbal and written communication skills
• Highly self-motivated; success driven and results oriented.
• Proficient with Microsoft Word and Excel
• Previous Experience with Pennsylvania Laws and Regulations is preferred.

• NAMSS trained and certified
• Participate in department and general staff meetings when scheduled.
• Plans and prioritizes work in accordance with department goals and objectives.
• Promotes department and CHDC in a positive manner; it works with all staff and patients in a courteous and professional manner.

Physical demands & work environment: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• Physical demands: While performing duties of job, employees are occasionally required to stand; walk; sit, use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms, talk, and hear. Employees must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
• Mental Demands: Stressful due to time constraints and multiple tasks/procedures occurring at the same time.
• Work environment : The noise level in the work environment is usually moderate.
• Manual Dexterity Required: Must be able to manipulate small electronic parts and controls.

Compliance Provision:

• This position requires compliance with Health Center's written standards, including its Standards of Conduct and policies and procedures ("Written Standards"). Such compliance will be an element considered as part of the employee's regular performance evaluation.
• Failure to comply with Health Center's Written Standards, which may include the failure to report any conduct or event that potentially violates legal or compliance requirements or Health Center's Written Standards, will be met by the enforcement of disciplinary action, up to and including possible termination, in accordance with Health Center's Compliance Program Policy and Procedure: Addressing Instances of Non-Compliance Through Appropriate Disciplinary Actions.

Americans with Disabilities Act Statement:

External and internal applicants, as well as position incumbents who become disabled, must be able to perform the essential job specific functions (listed within each job specific responsibility) either unaided or with the assistance of a reasonable accommodation to be determined by the organization on a case-by-case basis.

General sign-off : The employee is expected to adhere to all company policies and to act as a role model in the adherence to policies.

I have read and understand this explanation and job description.

_________________________________________ __________________

Signature Date