Credentialing and Privileging Specialist

Jane Pauley Community Health Center•Indianapolis, IN

About The Position

Jane Pauley Community Health Center is a Federally Qualified Health Center that provides integrated, whole-person care to individuals and families across Indiana, regardless of income or insurance status. The Credentialing and Privileging Specialist ensures licensed independent practitioners and advanced practice providers are appropriately onboarded, credentialed, and privileged before providing patient care. The role manages the provider lifecycle, including initial credentialing, privileging, re-credentialing, onboarding, and ongoing monitoring, while supporting compliance with HRSA Health Center Program requirements, FTCA deeming standards, accreditation standards, and payer requirements. Reporting to the Chief Human Resources Officer, the specialist partners closely with the Chief Medical Officer, clinical leaders, and teams across HR, Compliance, IT, Clinical Operations, Revenue Cycle, and site leadership. The CMO and clinical leadership retain authority over clinical privileging decisions. The specialist maintains accurate records, monitors deadlines and compliance risks, supports payer enrollment, and reports status and trends to senior and executive leaders. The role develops scalable policies and workflows as the organization grows, supports committee and governance processes, and serves as a primary contact for credentialing matters. Work is primarily office-based, with hybrid or remote flexibility depending on organizational policy, occasional travel between sites, extended computer use, and periods of higher intensity around reviews, renewals, audits, and rapid hiring cycles.

Requirements

At least 3 years of experience in healthcare credentialing, medical staff services, or provider enrollment.
Working knowledge of primary source verification, credentialing standards, and healthcare regulations.
Proficiency with credentialing software, HRIS platforms, Excel, and Microsoft Office.
Strong organizational skills and a demonstrated ability to manage high volumes and competing deadlines.
Excellent written and verbal communication skills, including the ability to present to senior leaders.
Commitment to confidentiality and discretion with peer review and personnel information.
An associate or bachelor's degree is preferred; a high school diploma or equivalent with relevant experience is accepted.

Nice To Haves

Experience in an FQHC, community health center, or other ambulatory setting.
Familiarity with HRSA Health Center Program requirements, FTCA deeming, and PCMH or other accreditation standards.
Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification, or willingness to obtain certification within 12–18 months.
Experience supporting multi-site organizations through rapid growth.
Experience coordinating onboarding with HR and building dashboards or executive reports.
Bilingual ability in English and Spanish or other languages relevant to the community.

Responsibilities

Coordinate and track provider and clinical staff onboarding from offer acceptance through the first day of patient care, partnering with relevant departments and site leadership.
Ensure onboarding steps are completed, including employment verification, background checks, health screenings and immunizations, required training, EHR access, badging, orientation, and competency validations.
Confirm providers do not begin independent patient care until credentialing, privileging, and onboarding requirements are met.
Maintain onboarding checklists, identify bottlenecks, and drive timely completion.
Process initial credentialing applications and manage the re-credentialing cycle according to organizational policies and applicable requirements.
Verify and monitor DEA and state-controlled substance registrations, work history, malpractice history, and hospital affiliations or admitting arrangements.
Query NPDB, OIG, SAM.gov, and state Medicaid and Medicare exclusion databases at appointment, re-credentialing, and on a continuous or monthly basis.
Follow up on gaps, discrepancies, and adverse findings; promptly escalate concerns to the CHRO, CMO, and compliance leadership.
Maintain accurate, complete, and confidential credentialing and privileging files.
Coordinate delineation of clinical privileges with the CMO and clinical leaders based on training, experience, demonstrated competence, and the health center’s HRSA-approved scope of project.
Prepare provider files for review and approval by the CMO, Credentialing Committee, and Governing Board or as specified by bylaws.
Track FPPE/OPPE, performance reviews, and peer review documentation required for re-privileging, obtaining clinical input from the CMO and designated peer reviewers.
Manage temporary privileges, including documentation and timely close-out.
Maintain credentialing and privileging files that meet FTCA deeming requirements and HRSA credentialing and privileging guidance.
Support the annual FTCA deeming application and renewal process, including provider data and documentation.
Assist with HRSA Operational Site Visits, audits, and corrective action plans related to credentialing, privileging, and onboarding.
Track compliance with applicable Joint Commission, AAAHC, or NCQA standards and state and federal regulations.
Track expiration dates for licenses, certifications, DEA registrations, malpractice or FTCA coverage, and other time-sensitive credentials; send reminders to providers and managers.
Maintain a master tracking system across sites and provider types, with proactive alerts for expirations and re-credentialing due dates.
Ensure providers are not scheduled for patient care when credentials have lapsed or are incomplete, and escalate issues immediately.
Submit and track provider enrollment and revalidation with Medicare, Medicaid, managed care organizations, and commercial payers.
Maintain CAQH profiles and coordinate with billing and revenue cycle teams to prevent enrollment-related delays and denials.
Provide regular leadership reports and dashboards on credentialing status, onboarding completion and time-to-start, expiring credentials, compliance risks, audit readiness, corrective actions, and turnaround-time trends.
Present findings and risks at leadership and committee meetings, recommend corrective actions, and provide data for workforce planning and recruitment.
Develop and refine policies, procedures, workflows, and templates with HR, the CMO, and Compliance to support growth and new sites.
Recommend and help implement credentialing technology solutions, including integration with the HRIS, to automate tracking and reporting.
Monitor HRSA, CMS, FTCA, and state regulatory changes and update processes accordingly.
Prepare agendas, files, and minutes for the Credentialing Committee and related governance meetings.
Serve as the primary point of contact for providers, hiring managers, and external agencies on credentialing matters.