The Credentialing Specialist is accountable for performing the credentialing, re-credentialing and privileging process for the organization.  The Credentialing Specialist reports directly to the System Director of Medical Affairs and Provider Enrollment.

• Processes and maintains provider credentialing and privileging files in accordance with organizational policies, regulatory requirements, and accreditation standards.
• Completes routine and assigned credentialing activities in an accurate and timely manner.
• Processes provider pre-applications and reviews submitted documentation for completeness.
• Prepares credentialing application packets and distributes them to providers for completion.
• Reviews and screens initial appointment and reappointment applications to ensure accuracy, completeness, and compliance with applicable policies, regulations, and guidelines.
• Identifies, analyzes, and resolves discrepancies, gaps in employment or training history, unusual findings, and other issues that may affect the credentialing process.
• Communicates credentialing concerns and potential issues to Medical Affairs to support informed decision-making in accordance with Medical Staff Bylaws and credentialing policies.
• Participates in the development, implementation, and continuous improvement of system-wide credentialing processes and procedures.
• Communicates effectively with providers, provider representatives, Medical Affairs personnel, Medical Staff leadership, and administrative staff regarding credentialing and privileging matters.
• Provides timely responses to requests and inquiries related to credentialing and privileging activities.
• Establishes and maintains accurate provider records within credentialing databases and related systems.
• Maintains current knowledge of healthcare regulations, accreditation standards, and credentialing best practices through continuing education, seminars, workshops, and professional affiliations.
• Performs primary source verification for all required credentialing elements.
• Coordinates with the Medical Staff Office to submit completed credentialing files for review, recommendation, and approval through established Medical Staff processes.
• Maintains strict confidentiality of provider information and credentialing records.
• Ensures the accuracy, integrity, and security of credentialing documentation and electronic records.
• Performs miscellaneous duties and special projects as assigned.