Credentialing Specialist - Full Time - Germantown, TN

West Cancer Center•Germantown, TN

9d•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 enrollments, and ensures compliance with regulatory and organizational requirements while protecting the confidentiality of provider information. The specialist works with providers, internal departments, hospitals, insurance companies, malpractice carriers, and other external organizations to support accurate and timely credentialing and enrollment. 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 writing 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 in Microsoft Office applications, including Word, Excel, and Access, as well as internet-based resources.

Nice To Haves

Three or more years of credentialing experience.

Responsibilities

Maintain current and 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 application status, and follow up on outstanding items.
Generate MD-App portals for new providers, help with 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 to 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 the group's malpractice carrier, SVMIC, and provide documentation needed for timely enrollment.
Ensure physicians complete annual SVMIC CME risk management requirements.
Assist the Finance Department with questions related to SVMIC statements.
Maintain knowledge of current payer and agency credentialing requirements.
Monitor health plan enrollment processes using MD-Staff workflows and checklists.
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 the Revenue Cycle team and billing staff to resolve credentialing-related denials and authorization issues.
Work collaboratively with peers, management, other West Cancer Center 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.