Credentialing Specialist

Job Description

** GENERAL SUMMARY :**

As a Credentialing Specialist, you'll play a vital role in our medical staff services team, ensuring that healthcare practitioners meet the highest standards of qualification and compliance. Under general supervision, you'll manage all credentialing and recredentialing functions for practitioner applicants, combining meticulous data management with strategic verification processes. Your work directly supports our commitment to patient safety and organizational excellence.

** PRINCIAL DUTUES AND RESPONSIBILITIES :**

• Drive the Credentialing Process Forward * Manage end-to-end credentialing for medical staff and allied health professionals, including initial appointments, provisional reviews, reappointments, and privilege delineation * Coordinate application processing with precision, ensuring all submissions are complete, accurate, and processed within established timelines * Conduct thorough primary source verification of credentials, maintaining compliance with organizational policies and regulatory requirements * Proactively track responses and follow up on outstanding items, keeping the process moving efficiently
• Maintain Data Integrity and Accuracy * Manage credentialing software databases with meticulous attention to detail, ensuring all data is complete, current, and audit-ready * Request and organize sensitive documentation including case logs, procedures, and confidential practitioner information * Submit completed files to MSO offices and delegated entities in compliance with all requirements
• Build Strategic Partnerships * Serve as a trusted liaison between Henry Ford Health System facilities and the Credentialing Services team * Communicate clearly and professionally with internal and external stakeholders to facilitate information exchange and resolve inquiries * Provide exceptional customer support aligned with corporate standards of excellence
• Ensure Regulatory Excellence * Support compliance with accrediting and regulatory agencies including The Joint Commission, NCQA, URAC, and HFAP * Develop and maintain working knowledge of relevant state and federal statutes and regulations
• Contribute to Continuous Improvement * Participate actively in system integration and quality improvement initiatives * Pursue professional development through industry organizations, seminars, and publications to stay current with medical staff services trends * Perform additional duties as assigned to support organizational goals

Qualifications:
Qualifications

** EDUCATION/EXPERIENCE REQUIRED: **

• High School Diploma required. Associate’s Degree, preferred.
• 1 year of credentialing, provider enrollment, or background/verification specialist experience required.
• High level of energy to work in a fast paced environment often including time deadlines, frequent interruptions, multiple demands and multi-tasking.
• Working knowledge of State and Federal law relating to due process and provisions of the Health Insurance Portability and Accountability Act if 1996 and all applicable standards.

Additional Information

PHYSICAL DEMANDS/WORKING CONDITIONS :

• Normal office environment with minimal exposure to noise, dust, or extreme temperatures.
• Must meet or exceed core customer service responsibilities, standards and behaviors as outlined in the HFHS’ Customer Service Policy
• Must practice the customer skills as provided through on-going training and in-services.