Credentialing Specialist

Credentialing Specialist

Job Title: Credentialing Specialist

Location: SBC Corporation

Department Name: Medical Staff

Req #: 0000264424

Status: Salaried

Shift: Day

Pay Range: $52,600.00 - $79,000.00 per year

Pay Transparency:

The above reflects the anticipated annual salary range for this position if hired to work in New Jersey.

The compensation offered to the candidate selected for the position will depend on several factors, including the candidate's educational background, skills and professional experience.

A Typical Day

The Credentialing Specialist is responsible for performing primary source verification and credentialing activities for physicians, advanced practice providers, allied health professionals, and other practitioners in accordance with organizational policies, accreditation standards, regulatory requirements, and delegated credentialing agreements.

Working within the Credentials Verification Organization (CVO), the Credentialing Specialist manages assigned credentialing files from intake through completion, ensuring accurate, timely and compliant verification of practitioner qualifications to support medical staff appointment, clinical privileging, payor enrollment, and network participation activities across the health system.

• Coordinates application management and verification activities, preliminary analysis of application and verification information
• Perform primary source verification of licensure, education, training, board certification, work history, malpractice coverage, sanctions, and other credentialing elements
• Analyze verification information, to include identifying red flag and/or adverse information and notifying central MSO leadership in accordance with policies
• Maintain a working knowledge of healthcare accreditation and regulatory standards, including requirements from Joint Commission, DNV, NCQA, CMS, and applicable state and federal regulations
• Management of database entries for accuracy and completeness
• Generate reports related to credentialing status, expirables, and operational metrics
• Monitor expiring credentials and coordinate renewal activities
• Serve as a resource to practitioners, medical staff professionals, payor representatives, and internal stakeholders regarding credentialing requirements
• Collaborate with local Medical Staff Offices, Provider Enrollment, Human Resources, Compliance, and departmental leadership
• Support organizational goals related to provider onboarding and credentialing timeliness
• Participation in special project teams as assigned

To Be Considered

Required:

• Associates degree required or a combination of equivalent education, training and experience may be considered
• At least two (2) years of experience CVO or Medical Staff Services in an acute healthcare setting, including credentialing and privileging

Certifications and Licenses Required:

• Certified Provider Credentialing Specialist (CPCS) certification preferred or willingness to obtain certification within 2 years of hire

Preferred:

Bachelors degree in healthcare administration or other related field preferred

Other Duties: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.