Description Position Summary:The Medical Credentialing Specialist is responsible for ensuring that healthcare providers meet all the necessary qualifications and standards required for licensure, certification, and employment. This role involves overseeing the credentialing and re-credentialing processes, ensuring compliance with regulatory requirements, and supporting medical staff in maintaining proper documentation and certifications. The ideal candidate will have a keen eye for detail, strong organizational skills, and experience in healthcare administration.Requirements Key Responsibilities:
Credentialing & Re-Credentialing:
Verify the professional qualifications, licenses, certifications, and experience of healthcare providers.
Ensure accurate and timely credentialing and re-credentialing of physicians, nurses, allied health professionals, and other clinical staff.
Obtain and review primary source verifications, including education, training, work history, and licensure status.
Prepare and submit applications for licensure, privileges, and certifications to various medical boards and insurance companies.
Compliance & Regulatory Adherence:
Ensure compliance with federal, state, and local regulations, as well as hospital/health system policies and standards.
Monitor the expiration of licenses, certifications, and medical privileges and take necessary steps to renew them before they lapse.
Stay informed on changing laws, regulations, and accreditation standards affecting credentialing practices.
Documentation & Record Management:
Maintain accurate and up-to-date records in credentialing databases and files.
Compile and review medical provider profiles and ensure completeness for approval by medical staff leadership.
Prepare and maintain credentialing reports, audits, and logs for internal and external review.
Collaboration:
Collaborate with medical staff, department heads, human resources, and insurance companies to ensure credentialing requirements are met.
Serve as a liaison between healthcare providers and third-party entities, including insurance companies and professional boards.
Respond to inquiries from medical staff, providers, or regulatory bodies regarding credentialing processes.
Quality Assurance & Process Improvement:
Continuously assess and improve credentialing processes to ensure efficiency and accuracy.
Perform regular audits of credentialing files to ensure completeness and compliance with all applicable standards.
Provide ongoing training and support to staff involved in credentialing processes.
Data Analysis & Reporting:
Prepare reports related to credentialing metrics, trends, and issues for leadership review.
Track and report on key performance indicators (KPIs) associated with credentialing timelines and outcomes.
Qualifications:
Education & Experience:
Associate’s degree in healthcare administration, business, or related field (Bachelor’s degree preferred).
Certification as a Medical Staff Credentialing Specialist (CMSC) or similar credentialing certification is a plus.
Minimum of [X] years of experience in medical credentialing, healthcare administration, or a related field.
Knowledge of medical terminology, healthcare regulatory standards, and credentialing software.
Skills & Competencies:
Strong attention to detail and ability to manage multiple tasks and deadlines.
Excellent communication and interpersonal skills for interacting with healthcare providers, staff, and external agencies.
Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) and credentialing software (e.g., IntelliCred, Verity, or similar).
Knowledge of accreditation standards (e.g., NCQA, URAC) and healthcare industry regulations.
Ability to maintain confidentiality and handle sensitive information with discretion.
Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more.All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.© 2024 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https://www.roberthalf.com/us/en/terms) .
