Credentialing and Privileging Specialist

Jane Pauley Community Health Center, Inc.•Indianapolis, IN

About The Position

The Credentialing and Privileging Specialist ensures licensed independent practitioners and advanced practice providers are properly onboarded, credentialed, and privileged before providing patient care. The specialist manages the provider lifecycle, including initial credentialing, privileging, re-credentialing, onboarding, and ongoing monitoring, supporting compliance with HRSA Health Center Program requirements, FTCA deeming standards, accreditation standards, and payer requirements. The role partners closely with the Chief Medical Officer and clinical leadership, who hold authority over clinical privileging decisions, and reports credentialing and onboarding status to senior and executive leaders. The position reports to the Chief Human Resources Officer. The specialist coordinates provider onboarding with HR and operational partners; processes credentialing and re-credentialing; prepares privileging materials and tracks professional practice evaluations; maintains regulatory compliance and complete, confidential files; monitors credential expirations; supports payer enrollment; and provides leadership reporting. The role also develops scalable processes, supports committees and governance meetings, and serves as a primary point of contact for credentialing matters. The position is primarily office-based, with hybrid or remote flexibility depending on organizational policy and occasional travel between sites. It involves extended computer use and handling sensitive documents, with higher-intensity periods around reviews, renewals, audits, and rapid hiring cycles.

Requirements

Associate or bachelor's degree preferred; high school diploma or equivalent with relevant experience accepted.
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 proven 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.

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), 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 in English/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, in alignment with HR processes.
Partner with Talent Acquisition, Compliance, IT, Clinical Operations, Revenue Cycle, and site leadership to complete onboarding steps such as employment verification, background checks, health screenings and immunizations, training, EHR access, badging, orientation, and competency validations.
Confirm providers do not begin independent patient care until credentialing, privileging, and onboarding requirements are complete.
Maintain onboarding checklists, identify bottlenecks, and support timely provider start dates.
Process initial credentialing applications in accordance with organizational policies, HRSA requirements, and applicable accreditation standards.
Manage re-credentialing and re-privileging cycles, ensuring completion on schedule.
Query NPDB, OIG, SAM.gov, and state Medicaid and Medicare exclusion databases at appointment, re-credentialing, and continuously or monthly.
Follow up on gaps, discrepancies, or adverse findings and promptly escalate concerns to the CHRO, CMO, and compliance leadership.
Maintain accurate, complete, and confidential credentialing and privileging files.
Coordinate clinical privilege delineation with the CMO and clinical leaders based on training, experience, 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 required 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 policy requirements.
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, and send reminders.
Maintain a master tracking system across sites and provider types, with alerts for upcoming 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 leadership reports and dashboards on credentialing status, onboarding completion and time-to-start, expiring credentials and compliance risks, audit readiness and corrective actions, and turnaround times and trends.
Present findings and risks at leadership and committee meetings and recommend corrective actions.
Provide data to support workforce planning and recruitment as the organization expands.
Develop and refine policies, procedures, workflows, and templates in coordination with HR, the CMO, and Compliance.
Recommend and help implement credentialing technology solutions, including integration with the HRIS, to automate tracking and reporting.
Stay current on 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.