Credentialing and Privileging Specialist

About This Opportunity

We are representing a confidential healthcare organization seeking a Credentialing and Privileging Specialist to join their team. This role coordinates and implements credentialing and privileging activities for medical staff and allied health professionals across their network.

The position focuses on the investigation and documentation of practitioner credentials, utilizing specialized knowledge to obtain verification of all aspects of a practitioner's background, training, and past practice. You'll work in accordance with Department of Health, Joint Commission, NCQA, URAC, and other regulatory standards.

Responsibilities

• Review medical staff and allied health practitioner appointment and reappointment applications for appropriateness of data against departmental and external requirements
• Determine primary sources for verifications in accordance with accreditation standards and verify/document such verification as required by external standards
• Perform follow-up and second source verification as needed, ensuring practitioners meet criteria for requested privileges
• Conduct focused professional practice evaluations, reappointments, changes in status or privileges, and temporary privileges as needed
• Evaluate all verifications for possible discrepancies and need for further investigation
• Notify supervisors and management of adverse or questionable responses from the verification process
• Document results of all verifications and inquiries as required by external regulatory standards
• Maintain and utilize credentialing and privileging software systems for tracking activities
• Maintain credential files for medical staff and allied health professionals according to Medical Staff Bylaws and all federal/state regulatory and accrediting agencies
• Assist in organization and development of monthly Credentials Committee and Allied Health Professional Subcommittee agendas to comply with Managed Care requirements

What We're Looking For

Required:

• High School diploma or GED
• 3 years of general office administration work in a business, education, or healthcare environment

Preferred:

• Associate's Degree
• 3 years with physician credentialing and privileging, medical education, hospital environment, health insurance, or managed care
• 1 year in customer service
• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM)

How We Work With You

Get A Job.ai is a recruiting firm representing this confidential employer. When you apply through our platform, one of our talent team members will screen your application and qualifications. If there's a strong match, we'll submit your profile to our client for consideration. Please do not contact the employer directly—all communication should flow through Get A Job.ai to ensure a smooth process.

Pay

Compensation details will be discussed during the screening process with our recruiting team.

Equal Employment Opportunity: Get A Job.ai is committed to inclusive hiring practices and does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, veteran status, or any other protected characteristic.