Credentialing Specialist

Monument Health Rapid City Hospital•Rapid City, SD

18h•Onsite

About The Position

Credentialing Specialists are responsible for completing credentialing and recredentialing activities, including verifying and maintaining the professional qualifications of physicians and providers to ensure compliance with regulatory standards (e.g., NCQA, The Joint Commission). The role also ensures the accuracy and integrity of credentialing data by maintaining complete, current, and up-to-date information in credentialing software systems and electronic files. Monument Health offers competitive wages and benefits on qualifying positions.

Requirements

High School Diploma/GED Equivalent in General Studies
Minimum 1 year healthcare experience

Nice To Haves

Associates degree in Healthcare
3+ years of Administrative Experience
3+ years of Healthcare Experience

Responsibilities

Responsible for processing initial and reappointment applications, performing primary source verifications including, but not limited to, board certifications, state licenses, professional databanks, federations, credential verification, and exclusion checks.
Communicates necessary information and requests to the Vice President Medical Affairs, Medical Staff Coordinator, and other department staff.
Maintains, monitors, and reports expirations of physician and practitioner licenses, insurance, DEA numbers, TB test results, and other items as required.
Maintains accurate, current physician and provider records through timely data entry and ongoing updates in credentialing databases and electronic files to support task tracking, provider communication, and secure document management.
Collaborates with internal stakeholders and external agencies to obtain, validate, and maintain accurate physician and provider data.
Communicates with physicians and providers to resolve discrepancies and obtain missing information throughout the credentialing and recredentialing process.
Maintains up-to-date knowledge of industry regulations and standards, ensuring full compliance at all times.
Assists and guides internal staff to ensure accurate and efficient completion of credentialing activities.
All other duties as assigned.