Credentialing Specialist - AOMC - FT - Days Rotation

Job Description

Job Description

Credentialing Specialist

The Credentialing Specialist coordinates and oversees medical staff activities in collaboration with the Senior Director of Medical Staff Services and Chief Medical Officer. This role requires sound judgment and the application of established policies and procedures to ensure compliance with organizational, state, and federal standards.

The Credentialing Specialist is responsible for ensuring that all medical staff and allied health professionals meet regulatory and accreditation requirements through accurate credentialing, privileging, and primary source verification. This position supports departmental operations to uphold the highest standards of quality and patient safety and serves as a knowledgeable resource, fostering collaboration across departments to promote excellence in practitioner performance and overall healthcare delivery.

What you'll do :

• Assists in the recruitment and onboarding process by reviewing applications and credentials to verify that all licensing, certification, and membership eligibility requirements are met.
• Analyzes credentialing and privileging applications for completeness and accuracy; communicates with practitioners regarding application status and outstanding documentation.
• Conducts and maintains primary source verification (PSV) for all required elements in accordance with NCQA, CMS, Joint Commission, and internal policy standards.
• Verifies professional education, training, certifications, and licensure to ensure compliance with federal, state, and accreditation requirements.
• Performs background checks, contacts licensing boards, confirms education and training details, and obtains peer and professional references.
• Coordinates and maintains ongoing professional practice evaluations (OPPE), focused professional practice evaluations (FPPE), and peer review activities to support credentialing and privileging decisions.
• Compiles, analyzes, and interprets practitioner-specific data for review by the Medical Executive Committee and other credentialing decision-making bodies.
• Maintains and updates credentialing and privileging databases within systems such as MDStaff to ensure data integrity and regulatory compliance.
• Performs initial credentialing, reappointment, and re-credentialing activities, including the processing of privilege and membership modifications.
• Ensures organizational compliance with medical staff bylaws, Joint Commission standards, and all applicable state and federal regulations.
• Supports medical staff operations including orientation, training, and maintenance of current provider files and rosters.
• Applies analytical and problem-solving skills to identify trends, assess process efficiencies, and recommend improvements that support patient safety and practitioner quality.
• Demonstrates flexibility in assuming additional responsibilities aligned with departmental goals and regulatory requirements.

Minimum Qualifications

• Associate's Degree or High School Diploma with a minimum of five (5) years of directly related medical staff or credentialing experience.
• CPCS certification preferred (or commitment to obtain certification within an established timeframe).
• In lieu of the stated education requirement, an equivalent combination of relevant work experience, certification, and demonstrated expertise may be considered.
• Primarily a sedentary work environment requiring extended periods of computer and desk work.

Preferred Qualifications :

• Minimum of five (5) years of experience in a Medical Staff Services or Credentialing environment.
• Strong oral and written communication skills with the ability to interact professionally with practitioners, leadership, and regulatory bodies.
• Proficiency in Microsoft Office applications, including Word, Excel, and PowerPoint.
• Demonstrated ability to manage confidential information with a high level of integrity and discretion.
• Excellent organizational skills with the ability to prioritize work, manage multiple deadlines, and set short- and long-term goals aligned with departmental objectives.
• Working knowledge of clinical competence evaluation processes, medical staff bylaws, and regulatory standards, including Joint Commission, NYS, NCQA, and CMS requirements.
• Familiarity with MDStaff credentialing software, and multi-hospital system environments.

Physical Requirements:

This position is classified as sedentary work and primarily involves sitting for extended periods while performing computer-based tasks. Occasional standing, walking, reaching, and lifting of office materials up to 25 pounds is required. The employee must be able to effectively operate standard office equipment and communicate with staff, providers, and external agencies.