Credentialing Specialist

Company Description St. Charles Surgical Hospital, LLC is a specialized healthcare facility and the only hospital in the world dedicated exclusively to breast reconstruction. Located in New Orleans, LA, the hospital is globally recognized for providing advanced breast reconstructive surgical services in a patient- and family-focused environment. Its mission emphasizes healing, compassion, and excellence in surgical care. Team members collaborate to deliver a supportive experience for patients and their families throughout the reconstructive journey. Credentialing Specialist About the Role We are seeking a highly organized and detail-oriented Credentialing Specialist to join our Human Resources team. This position will play a critical role in coordinating the credentialing and recredentialing of physicians and other clinical providers across both our clinic and hospital environments. The Credentialing Specialist will manage the credentialing lifecycle from initial application through ongoing maintenance, including physician credentialing, hospital medical staff applications and privileges, payer enrollment, licensing, certifications, and recredentialing. This is an excellent opportunity for a healthcare professional who enjoys working independently, managing multiple deadlines, building relationships with physicians and healthcare organizations, and ensuring that providers are fully credentialed and ready to practice. What You’ll Do Physician & Clinic Credentialing * Coordinate initial and recredentialing processes for physicians and applicable advanced practice providers. * Collect, verify, and maintain provider credentials, including medical licenses, DEA registrations, board certifications, NPI information, malpractice coverage, education, training, work history, and other required documentation. * Manage provider enrollment and credentialing applications for commercial insurance plans, Medicare, Medicaid, and other payers. * Maintain and monitor provider information in CAQH and other credentialing systems. * Track license, certification, insurance, and other expiration dates and proactively initiate renewals. * Maintain accurate and audit-ready electronic credentialing files. Hospital Credentialing & Privileging * Coordinate initial appointments and reappointments with affiliated hospitals and healthcare facilities. * Prepare and submit medical staff applications and supporting documentation. * Coordinate hospital credentialing, privileging, and onboarding requirements. * Track hospital privileges, committee review dates, temporary privileges, and reappointment deadlines. * Communicate with hospital Medical Staff Offices regarding application status, missing documentation, and outstanding requirements. * Assist with changes to privileges, practice locations, hospital affiliations, and scope of practice. Provider Onboarding * Partner with Human Resources, physician leadership, practice leadership, and hospital Medical Staff Offices to coordinate provider onboarding. * Develop provider-specific credentialing checklists and timelines. * Monitor credentialing progress and communicate outstanding requirements to physicians and leadership. * Help ensure providers complete all required credentialing and enrollment activities prior to their anticipated start dates. Compliance & Administration * Conduct primary-source verification of licenses, certifications, education, training, and other credentials as required. * Maintain accurate credentialing records in accordance with regulatory, accreditation, payer, and organizational requirements. * Assist with credentialing audits and regulatory/accreditation surveys. * Maintain credentialing databases, tracking reports, and credentialing calendars. * Identify potential credentialing delays or compliance issues and escalate them appropriately. * Develop and maintain standardized credentialing procedures, checklists, and workflows. * Maintain strict confidentiality of provider and organizational information. * Provide regular credentialing status updates to the Director of Human Resources and leadership. What We’re Looking For * 2–4 years of experience in provider credentialing, medical staff services, payer enrollment, healthcare administration, or a related healthcare field. * Experience with physician credentialing and/or hospital medical staff credentialing. * Strong understanding of credentialing, privileging, and provider enrollment processes. * Experience working with CAQH, payer enrollment systems, or hospital credentialing systems preferred. * Strong organizational and time-management skills. * Exceptional attention to detail and follow-through. * Ability to manage multiple providers, applications, facilities, and deadlines simultaneously. * Excellent written and verbal communication skills. * Ability to maintain confidentiality and exercise sound judgment when handling sensitive information. * Proficiency with Microsoft Office, particularly Excel, Word, and Outlook. Preferred Qualifications * Experience managing both clinic/provider credentialing and hospital credentialing. * Knowledge of Medicare, Medicaid, and commercial payer enrollment. * Familiarity with hospital medical staff bylaws and privileging processes. * Experience with credentialing databases or provider enrollment software. * CPCS, CPMSM, or another credentialing-related certification is preferred but not required. * Bachelor’s degree in healthcare administration, business, human resources, or a related field is preferred. What Makes This Role Important Our physicians and clinical providers depend on an efficient credentialing process to begin and maintain their ability to practice. In this role, you will serve as a key point of coordination between physicians, Human Resources, clinic leadership, hospitals, payers, and regulatory organizations. You will have the opportunity to help build and improve credentialing processes within a growing healthcare organization while taking ownership of an important area of provider operations. Our Ideal Candidate You are someone who: * Notices the details others miss. * Keeps excellent records and never loses sight of a deadline. * Can manage multiple credentialing applications without losing track of the bigger picture. * Is comfortable following up persistently and professionally with busy physicians, hospitals, and external organizations. * Can work independently while knowing when an issue needs to be escalated. * Takes ownership rather than waiting to be asked. * Enjoys creating structure and improving processes. * Understands that excellent credentialing directly supports patient care and business operations. If you are an experienced healthcare credentialing professional who is ready to take ownership of physician and hospital credentialing in a growing organization, we would love to hear from you.aa415a4b-8b21-40fc-a65c-70d2b25ca29a