Credentialing Specialist

SPS Health LLC•Milwaukee, WI

5d•$52,000 - $60,000•Hybrid

About The Position

The Credentialing Specialist is responsible for ensuring that all pharmacy providers and facilities meet the necessary accreditation, licensure, and compliance standards. This role involves verifying credentials, maintaining up-to-date records, and ensuring adherence to organizational and regulatory policies. The ideal candidate will have exceptional organizational skills, attention to detail, strong communication abilities, and the ability to lead and manage multiple tasks in a fast-paced environment.

Requirements

High School Diploma or equivalent required; associate or Bachelor’s degree strongly preferred
Two (2) experience in credentialing, medical staff services, or related field in healthcare administration
Knowledge of healthcare accreditation standards (e.g. The Joint Commission, NCQA, URAC)
Well-organized and detailed with the ability to communicate in an appropriate and timely manner.
Ability to manage multiple tasks and meet deadlines in a fast-paced environment.

Nice To Haves

Certification as a Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) is a plus but not required.

Responsibilities

Collect, verify, and maintain healthcare providers' credentials, licenses, certifications, and education records.
Ensure timely renewal of licenses and certifications to maintain compliance with organizational and regulatory requirements.
Process initial and reappointment credentialing applications for providers in accordance with established guidelines and timelines.
Communicate with providers to address incomplete or missing documentation.
Monitor and update databases with accurate provider and credentialing and licensing documentation.
Collaborate with state licensing boards, OIG/SAM, insurance companies, and accrediting bodies to confirm provider credentials.
Stay up to date on current laws, regulations, and standards related to pharmacy credentialing.
Prepare reports on credentialing activities and compliance audits for management as needed.
Maintain confidentiality and security of sensitive provider information.
Performs other duties and responsibilities as requested or required.
Follows company policies and procedures.