Credentialing Specialist

HopeHealth Inc • Florence, SC

4h

About The Position

The Credentialing Specialist is responsible for verifying, maintaining, and monitoring the credentials of healthcare providers to ensure compliance with regulatory, accreditation, and organizational standards. This role plays a critical part in supporting patient safety, payer enrollment, and operational readiness by ensuring all practitioners are properly credentialed and re-credentialed in a timely manner.

Requirements

• Knowledge of credentialing standards
• Proficiency with credentialing software and Microsoft Office
• Strong attention to detail and organizational skills
• Familiar with provider credentialing and recredentialing requirements
• Strong analytic, computer and software skills
• Excellent interpersonal skills including excellent verbal and written communication skills
• Ability to demonstrate a high degree of trust and confidentiality
• Ability to work independently and assume assigned responsibilities
• Skilled in efficiency, organization, time management, and prioritization
• Ability to be flexible and function well in a fast-paced environment
• Ability to deal with problems involving several concrete variables in standardized situations
• Ability to communicate effectively and relate to people of different cultures
• Associate’s in business or health science
• Experience: Two years of relevant credentialing experience in a physician practice setting

Nice To Haves

• Bachelor’s degree preferred
• Human Resources experience a plus
• Certified Provider Credentialing Specialist (CPCS) a plus

Responsibilities

• Compiles and maintains current and accurate credentialing records for Licensed Independent Providers (LIPs), Other Licensed Clinical Practitioners (OLCPs), and Clinical Staff (OCS).
• Prepare and process initial credentialing and re-credentialing applications for practitioners.
• Audits credentialing applications for accuracy, completeness, and compliance prior to submission
• Monitors application status and communicates with practitioners to obtain required documentation and ensure timely completion.
• Conducts research to obtain necessary information and supporting documentation required for payer enrollment.
• Enters and updates practitioner data within online credentialing platforms and the CredentialMyDoc system.
• Perform Primary Source Verification (PSV) of education, state licensure, DEA registration, and board certifications in accordance with regulatory and payer requirements.
• Investigates and resolves discrepancies including time gaps, incomplete histories, and documentation inconsistencies impacting payer enrollment.
• Reviews and submits credentialing and supporting documentation to department leadership for review and approval.
• Tracks expirations of licenses, DEA registrations, and board certifications to ensure on-time renewals and continuous compliance.
• Maintains copies of active state licenses, DEA certificates, malpractice insurance, and credentialing documentation for all practitioners and clinical staff.
• Supports and serves as back up for the Director of Credentialing
• Assists with additional administrative and credentialing duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree