Credentialing Specialist

## Description

The Credentialing Coordinator will organize, maintain, and verify all aspects of the process, and maintain current files on practitioners. You will track the expiration of certifications to maintain up-to-date files and assist health plan providers and customers with phone inquiries.

Essential Functions

• Processing initial credentialing and re-credentialing applications.
• Screening practitioners' applications and supporting documentation to ascertain their eligibility.
• Collecting information from the National Practitioner Data Bank (NPDB), the applicant and their malpractice insurer, and other relevant sources.
• Identifying discrepancies in information and conducting follow-ups.
• Assisting medical staff with credentialing inquiries.
• Responding to health plan provider inquiries.
• Capturing primary source documentation in computer databases.
• Ensuring data is backed up.
• Ensuring compliance with applicable laws, regulations, procedures, and policies.
• Knowledge of medical credentialing and privileging procedures and standards.
• Excellent verbal and written communication skills.
• Proficient with Microsoft Office Word and Excel.

## Qualifications

Qualifications

• Education: High School diploma
• Licenses/Certification: NAMSS certification or Certified provider credentials specialist
• Experience: 2+ years of credentialing experience with hospital medical staff.