Credentialing Specialist

Hamzavi Dermatology•Clinton Township, MI

8h•Hybrid

About The Position

We are seeking an experienced, highly organized, and detail-oriented Credentialing Specialist to join our Practice Operations team in Clinton Twp. This is a key position responsible for managing the credentialing, licensing, payer enrollment, hospital privileges, professional liability insurance, compliance tracking, and onboarding/offboarding processes for our healthcare providers. This position is ideal for someone who enjoys managing complex administrative processes, working independently, meeting deadlines, solving problems, and maintaining highly confidential information. The Credentialing Specialist plays an essential role in ensuring that physicians, advanced practice providers, and nursing professionals maintain all required credentials and remain eligible to practice across applicable locations, hospitals, networks, and insurance plans.

Requirements

Minimum of 3 years of experience in medical credentialing, provider enrollment, healthcare administration, practice management, or a related field
Strong knowledge of physician and advanced practice provider credentialing
Experience with CAQH, NPI, DEA, state licensing, payer enrollment, hospital credentialing, and professional liability insurance
Excellent organizational and time-management skills
Exceptional attention to detail
Ability to manage multiple providers, entities, deadlines, and projects simultaneously
Excellent written and verbal communication skills
Ability to handle confidential and sensitive information with discretion
Proficiency with Microsoft Office and electronic document management systems
Ability to work independently and exercise sound judgment
Strong follow-up, problem-solving, and communication skills

Nice To Haves

Highly organized and detail-oriented
Proactive rather than reactive
Dependable and accountable
Comfortable managing multiple deadlines
A strong communicator and relationship builder
Discreet and trustworthy
Able to work independently with minimal supervision
Comfortable navigating complex credentialing and administrative requirements
Skilled at identifying potential problems before they become issues
Committed to accuracy, compliance, and excellent service

Responsibilities

Manage and maintain credentialing requirements for MD/DOs, PAs, NPs, and RNs, including ACLS and BLS certifications, Board certifications, Annual board certification fees and CCP requirements, CAQH profiles, CLIA certificates for all locations, CME funds and CME tracking, Curriculum vitae (CV) maintenance, Provider demographic and identifying information, Driver's license information and expiration dates, ECFMG documentation, Provider education and training records, Influenza vaccination tracking, Letters of recommendation, TB testing and expiration tracking, UPIN tracking, W-9 documentation for CAQH.
Manage applications, renewals, documentation, and tracking for professional licenses for MD/DO, PA, NP, and RN providers, Full and limited physician licenses, Controlled substance licenses, DEA licenses, Individual and corporate NPI applications and updates, MiPLUS applications and renewals, HIPAA taxonomy codes, Provider and organizational records, Provider addresses and telephone numbers, Facility addresses, telephone numbers, and fax numbers, EIN applications and tracking, Other regulatory and compliance documentation.
Coordinate hospital credentialing and medical staff requirements, including Initial hospital appointments, Hospital reappointments, Appointment and reappointment letters, Hospital privileges, Hospital privilege grids and master lists, Hospital staff dues, Hospital login information, Hospital credentialing documentation and deadlines, Communication and follow-up with hospitals and medical staff offices.
Manage provider participation and documentation requirements for insurance carriers and healthcare networks, including Network applications, Network credentialing and recredentialing, Network payments and tracking, Network appointment letters, Payer documentation and deadlines, Provider information required by billing and payer organizations, Maintenance of payer and network records.
Manage professional liability insurance requirements, including New PLI applications, Policy renewals, Claims and Notices of First Report, Litigation documentation and tracking, Certificates of Insurance (COIs), Distribution of COIs to CAQH, hospitals, and networks, PLI tribute plan administration, Communication with insurance carriers and brokers, Maintaining current insurance documentation.
Coordinate the credentialing and administrative components of provider onboarding and offboarding, including New provider credentialing, Collection and review of required documentation, CAQH setup and maintenance, License and verification, NPI and payer enrollment, Hospital credentialing, Network credentialing, Professional liability insurance requirements, Provider database setup, Location assignments, Coordination with the Billing Manager, Offboarding and termination of applicable credentials, payer relationships, hospital privileges, and accounts, Communication and coordination with billing, management, and other departments.
Maintain accurate and confidential provider and organizational records.
Proactively monitor expiration dates and renewal deadlines.
Prevent lapses in licenses, certifications, insurance, hospital privileges, and payer participation.
Maintain organized electronic and hard-copy files.
Develop and maintain effective credentialing tracking systems.
Ensure documentation is complete, accurate, and submitted on time.
Follow up consistently with providers, hospitals, insurance carriers, networks, government agencies, and professional organizations.
Identify upcoming deadlines and communicate them proactively.
Work closely with the Billing Manager and Practice Leadership.
Maintain strict confidentiality of sensitive provider and organizational information.
Support regulatory and compliance readiness.
Resolve credentialing and administrative issues efficiently.
Develop and maintain professional relationships with external organizations and vendors.
Independently manage multiple priorities, projects, and deadlines.