Job Description

Position Overview

The Credentialing Specialist is responsible for coordinating and managing all aspects of provider credentialing and re-credentialing activities. This role ensures that all medical staff, allied health professionals, and other designated providers meet organizational, regulatory, and accreditation requirements prior to practicing. The position requires strong healthcare experience, exceptional attention to detail, and proficiency with credentialing systems.

This is a fully onsite position .

Key Responsibilities

Credentialing & Re-Credentialing

• Facilitate the complete credentialing lifecycle for initial appointments, reappointments, and ongoing audits.
• Manage clinical privileging processes for medical staff and allied health professionals in accordance with policies, procedures, and bylaws.

Primary Source Verification

• Perform and document primary source verification for new and existing providers.
• Ensure compliance with verification standards and due diligence requirements.

License & Certification Management

• Track and ensure timely renewal of provider licenses and certifications prior to expiration.
• Update provider files and databases promptly as renewals are completed.

Records Management & Data Integrity

• Maintain accurate, organized, and up-to-date provider credentialing files.
• Ensure consistency and accuracy in all credentialing database entries.
• Utilize software tools to monitor status alerts, run reports, and review scanned documentation.

Compliance & Regulatory Standards

• Interpret and apply standards from accrediting and regulatory agencies.
• Maintain working knowledge of laws, statutes, and regulations related to credentialing.

Software & Technology

• Use MDStaff credentialing software (or similar systems) for data entry, tracking, and monitoring credentialing activities.

Team Support & Backup Coverage

• Provide credentialing support for other members of the credentialing team as needed to ensure continuity of operations.

Minimum Required Skills & Qualifications

• Bachelors Degree Required.
• Healthcare Field Experience Previous experience working within a healthcare environment is mandatory.
• Credentialing Expertise Hands-on experience with provider credentialing and privileging.
• Primary Source Verification Skills Ability to conduct and document all required verification activities.
• MDStaff or Equivalent Software Proficiency Experience managing data within credentialing systems.
• Regulatory Knowledge Understanding of accreditation and regulatory standards governing credentialing activities.
• Exceptional Attention to Detail Ability to ensure accuracy, consistency, and data integrity.
• Records Management Skills Experience maintaining comprehensive, compliant credentialing files.
• Backup Capability Ability to step in for other credentialing team members when coverage is needed.

Pride Health offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.

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