Senior Credentialing Specialist

Ardent Health • Nashville, TN

2d

About The Position

Performs full primary source verification and file construction for initial credentialing and recredentialing across Ardent facilities and the managed care network. Serves as a subject matter expert and lead reviewer for complex provider files.

Requirements

• At least 3 years of experience with provider credentialing and primary source verification.
• Strong understanding of provider credentialing requirements.
• Knowledge of credentialing regulatory and accreditation standards, including NCQA, URAC, TJC, CMS, and state DOI requirements.
• High attention to detail and demonstrated accuracy in high-volume work.
• Proficiency with credentialing software and standard office applications.

Nice To Haves

• CPCS certification, or eligibility with intent to certify.
• Experience in a hospital, health system, CVO, or managed care setting.

Responsibilities

• Conduct primary source verification of licensure, DEA registration, board certification, education and postgraduate training, work history, malpractice coverage and claims history, and hospital affiliations.
• Query the NPDB and applicable exclusion and sanctions databases, including OIG, SAM, and state-level lists, and document results.
• Review high-risk and complex credentialing files as assigned or when additional support is needed.
• Provide staff training and mentoring on credentialing standards and serve as a subject matter expert when needed.
• Perform quality reviews of completed credentialing files and resolve outstanding issues or errors.
• Monitor data governance and identify trends and opportunities for process improvement.
• Meet productivity and turnaround standards determined by leadership.
• Maintain accurate, audit-ready documentation of every verification attempt and outcome.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed