Credential Specialist II

Credentialing Specialist II

The Credentialing Specialist II is responsible for managing the end-to-end credentialing and privileging process for physicians across a multi-state hospital system. This mid-level role requires strong knowledge of regulatory requirements and the ability to work independently while ensuring compliance with state-specific regulations, accreditation standards, and organizational policies. The specialist collaborates with medical staff leadership, providers, and administrative teams to ensure timely and accurate credentialing operations.

Key Responsibilities

• Manage full-cycle credentialing and recredentialing processes for physicians across multiple hospital locations and states to ensure compliance with payors.
• Perform thorough primary source verification of licensure, board certifications, education, training, work history, and malpractice coverage
• Ensure compliance with federal, state-specific, and accreditation standards (e.g., Joint Commission, NCQA, CMS) across all facilities
• Maintain and update provider credentialing files and databases with a high degree of accuracy
• Monitor and track expiration dates for licenses, certifications, DEA registrations, and privileges; ensure timely renewals
• Ensure that both facility and provider are credentialed with all payors to ensure proper payment from the payor.
• Interpret and apply medical staff bylaws, rules, and regulations across multiple facilities
• Serve as a liaison between providers, department leaders, and administrative teams to resolve credentialing issues
• Assist with payer enrollment and revalidation for multiple states as needed
• Participate in internal audits, regulatory surveys, and accreditation reviews; ensure readiness at all times
• Identify process improvement opportunities and support standardization across the health system
• Maintain strict confidentiality and compliance with HIPAA and data security standards

Knowledge, Skills & Abilities

• Strong working knowledge of credentialing standards (Joint Commission, NCQA, CMS)
• Understanding of multi-state licensure requirements, credentialing variations, and regulatory compliance
• Familiarity with medical staff bylaws and privileging processes across multiple facilities
• High attention to detail with strong organizational and time management skills
• Ability to work independently and manage a high-volume workload with competing priorities
• Strong analytical and problem-solving skills
• Excellent written and verbal communication skills
• Proficiency with credentialing software systems and Microsoft Office Suite (especially Excel)
• Ability to maintain professionalism and discretion when handling sensitive provider information

EDUCATION / EXPERIENCE Education:

• High school diploma or equivalent required
• Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or related field preferred

Experience:

• 35 years of credentialing experience in a hospital or multi-facility healthcare system
• Demonstrated experience with physician credentialing and privileging required
• Experience working with multi-state licensure and regulatory requirements strongly preferred

Certifications (Preferred):

• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM)

PHYSICAL DEMANDS

• Prolonged periods of sitting and computer use
• Ability to lift up to 15 pounds occasionally

WORK CONDITIONS

• On-site role within the corporate office
• May require occasional travel between facilities within the health system
• Regular interaction with physicians, leadership, and administrative staff
• Occasional early morning or late afternoon meetings for medical staff committees

Additional Information This role is critical in supporting a geographically diverse healthcare system by ensuring providers meet all credentialing and privileging standards across multiple states. The Credentialing Specialist II helps maintain regulatory compliance, supports patient safety, and contributes to efficient provider onboarding and retention.