Credentialing Specialist

Credentialing And Privileging Manager

Manages credentialing and privileging for Medical and Dental Staff, Licensed Independent Practitioners, non-physician providers, residents, fellows, students, and volunteers; prescreens applications, verifies qualifications, licensure, competency, and required Indian Health Service documentation, and ensures privileges align with training and experience.

Ensures compliance with applicable regulatory, accreditation, and facility requirements; monitors appointments, reappointments, temporary and modified privileges, and maintains accurate, confidential records with timely expiration notifications.

Conducts background research and primary-source verification of references, hospital affiliations, licensure, disciplinary actions, suspensions, revocations, and privilege restrictions; performs investigations as directed and verifies qualifications before review.

Coordinates credentialing, privileging, and appointment processes, including background clearances, affiliation and privilege verification, additional privilege requests, supporting documentation, and appointment and reappointment lists; ensures compliance with Medical Staff Bylaws and policies.

Manages automated systems to track expirations, appointments, privileges, peer reviews, and provider access; coordinates provider rotations, enrollment, background clearances, system access, housing, and orientation with appropriate departments.

Identifies and coordinates technical services, supplies, equipment, professional references, journals, and other resources needed to support program operations; provides technical assistance to supervisors, and preparing materials and presentations.