Credentialing and Privileging Specialist
About The Position
The Credentialing and Privileging Specialist is responsible for reviewing and authenticating the credentials, qualifications, licenses, and certifications of healthcare providers to ensure they meet required standards and comply with all legal and regulatory requirements. This includes performing primary and secondary source verification, querying national databases like the National Practitioner Data Bank (NPDB) and HHS-OIG List of Excluded Individuals/Entities, and maintaining accurate and confidential credentialing databases. The specialist will track expiration dates, collect and organize documents, communicate with healthcare providers regarding discrepancies, and coordinate with internal and external agencies. Additionally, the role involves assisting in preparing for and participating in audits and regulatory reviews, and monitoring compliance with clinical staffing and credentialing standards as defined by the HRSA Health Center Program Compliance Manual.
Requirements
- Bachelor's degree in healthcare administration, Business or related field
- Minimum of two (2) years of experience in healthcare credentialing or a related field
- Strong understanding of healthcare regulations and compliance standards, such as FTCA and HRSA
- Excellent attention to detail and strong organizational skills
- Strong analytical, problem solving and interpersonal skills are necessary for effective communication with healthcare providers and internal teams
- Proficiency in using credentialing software and databases for data entry and maintenance
Responsibilities
- Review and authenticate the credentials, qualifications, licenses and certifications of healthcare providers to ensure they meet required standards
- Performs primary source verification of education, professional licensure, and certifications and secondary source verification of identification (government issued ID) and DEA registration
- Responsible for querying the National Practitioner Data Bank (NPDB) for all reportable provider types and checking the HHS-OIG List of Excluded Individuals/Entities
- Ensure that healthcare professionals comply with all legal and regulatory requirements, including maintaining up-to-date licenses and certifications
- Maintain and update credentialing databases, tracking expiration dates of licenses and certifications and ensuring the accuracy and confidentiality of data
- Collect and organize important documents from healthcare providers, ensuring all records are accurate and complete
- Communicate with healthcare providers to address discrepancies or missing information and coordinate with internal departments and external agencies to facilitate the credentialing process
- Assist in preparing for and participating in audits and regulatory reviews
- Monitor license and credential expiration dates and advise staff members of required "renew by" dates
- Compliance monitoring - ensures compliance with clinical staffing and credentialing standards as defined by the HRSA Health Center Program Compliance Manual
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
1-10 employees
