Credentialing Specialist - Full Time - Germantown, TN

West Cancer Center•Germantown, TN

8d•Onsite

About The Position

The Credentialing Specialist maintains active credentialing status for providers by completing initial and ongoing credentialing, privileging, licensing, and enrollment requirements for hospitals, surgery centers, and commercial and government payers. The role maintains provider information across credentialing databases, manages state licensure and DEA renewals, coordinates provider enrollment, and ensures compliance with regulatory and organizational requirements while protecting confidential provider information. The specialist works with providers, internal departments, hospitals, health plans, insurance companies, and malpractice carriers to process applications, track renewals and enrollment, maintain accurate records, respond to inquiries, and resolve credentialing-related issues. The position is based in a typical office environment and involves frequent use of computers and credentialing software systems.

Requirements

High school diploma or GED.
At least three years of experience in a medical practice business office.
Ability to organize and prioritize work while managing multiple priorities.
Excellent verbal and written communication skills, including preparing letters, memos, and email correspondence.
Excellent attention to detail.
Ability to research and analyze information.
Ability to work independently with minimal supervision.
Ability to establish and maintain effective working relationships with providers, leadership, staff, and external organizations.
Proficiency with Microsoft Office applications, including Word, Excel, and Access, and with internet-based resources.

Nice To Haves

Three or more years of credentialing experience.

Responsibilities

Maintain accurate provider information in external credentialing databases and the MD-Staff credentialing system, including CAQH Universal Data Source.
Complete provider credentialing and recredentialing applications, monitor their status, and follow up on outstanding items.
Generate MD-App portals for new providers, answer portal-related questions, verify application accuracy, and upload information into MD-Staff.
Complete and submit initial Tennessee, Mississippi, and Arkansas medical license applications and supporting documentation.
Monitor expiration dates for state medical licenses, DEA registrations, life support certifications, and board certifications, and ensure timely renewals.
Maintain current copies of state licenses, board certifications, DEA certificates, malpractice coverage, allied health provider protocols, and other required credentialing documents.
Manage MD-Staff workflows, application progress, and checklist completion.
Coordinate provider enrollment and status changes with SVMIC, provide required documentation, and ensure physicians complete annual SVMIC CME risk management requirements.
Assist the Finance Department with questions related to SVMIC statements.
Monitor health plan enrollment processes using MD-Staff workflows and checklists, and keep practice location information current with health plans, agencies, and other credentialing entities.
Process applications for hospital appointments and reappointments.
Audit health plan directories to ensure provider information is accurate.
Create, schedule, and generate ad hoc queries and reports in MD-Staff for credentialing and enrollment requests.
Monitor credentialing email communications and respond professionally to providers, outside entities, leadership, and staff.
Collaborate with Revenue Cycle and billing staff to resolve credentialing-related denials and authorization issues.
Work collaboratively with peers, management, other departments, hospitals, insurance companies, and malpractice carriers.
Coordinate with the EMR team to obtain provider case logs for hospital reappointments.
Provide credentialing and privileging verifications.
Maintain confidentiality of provider information.
Complete urgent credentialing-related projects and other duties as assigned.