Credentialing Specialist Casual

Description

A Credentialing Specialist makes sure healthcare providers meet the necessary qualifications to provide care.

The primary responsibility is to verify and assess the credentials of providers to ensure compliance with industry

standards and regulatory requirements. This includes reviewing applications, verifying their qualifications such

as education, licensure status, certifications, or other credentials by directly contacting institutions, licensing

boards and previous employers to validate the information provided is accurate and up-to-date. They conduct

thorough background checks to identify any potential risks or red flags that may impact patient safety. The

Credentialing Specialist reviews privileges requested by the healthcare provider, compares to their education

and training, contrasted with relevant experience to recommend if the individual is qualified to provide safe and

competent patient care. The Credentialing Specialist ensures healthcare providers maintain their credentials by

monitoring expiration dates of licenses and certifications. They may facilitate the process of updating

credentials as required to ensure the caregiver and facilities remain compliant with all certification and

accreditation requirements. They also serve as a point of contact for credentialing related inquiries and assists in

the preparation of necessary reports. In addition to being responsible for updating and maintaining

credentialing databases, scheduling and attending meetings, data entry/integrity, record management and

performing other administrative tasks as assigned. This individual plays a key role in maintaining the integrity of

healthcare delivery and protecting patient well-being.

Required Education: Bachelor's degree in a health-related field or equivalent experience

Must possess a valid National Association Medical Staff Services (NAMSS) Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS); within two years from the date of hire and when meeting the eligibility criteria

Required Experience: Experience in medical credentialing, health care administration, or related field