Primary Function / General Purpose of Position

The Credentialing Specialist facilitates Credentials Verification Organization (CVO) provider application and data collection, application processing, and Primary Source Verification (PSV) for the organization. The role supports the organization’s onboarding and offboarding processes while following established standard operating procedures and market-specific medical staff bylaws. It requires exceptional customer service, communication skills, reliability, and commitment to quality.

Essential Job Functions

(Essential functions are the reason the job exists.)

• Responsible for timely and accurate initial credentialing and re-credentialing of affiliated network practitioners, including primary source verification and additional requirements.
• Assists the Credentialing Manager in conducting regulatory compliance audits of delegated healthcare entities; prepares and presents findings, conclusions, and recommendations.
• Collaborates with leadership on reviewing and continuously improving department policies and procedures.
• Manages ongoing monitoring and timely re-verification of expiring credentials in accordance with applicable regulatory standards.
• Processes provider initial and re-appointment applications; ensures completion, escalates concerns to the Medical Staff Office as needed, and prepares profiles for review.
• Updates provider demographic information and data changes as directed; follows guidelines on provider information disclosure; ensures accuracy through proactive and reactive quality audits.
• Processes provider access requests as needed.

This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Additional job-related tasks may be assigned by the supervisor as needed, subject to reasonable accommodation.

Licensing / Certification

• Certified Professional Medical Staff Management (CPMSM) or Certified Professional Credentials Specialist (CPCS) by the National Association of Medical Staff Services (NAMSS) (preferred)

Education

• High School Diploma or GED (required)
• Bachelor’s Degree in Business, Healthcare, or related field (preferred)

Work Experience

• 1 year of experience in medical staff services or a CVO setting (preferred)
• Knowledge of regulatory and accreditation rules, regulations, guidelines, standards, and requirements
• Experience with HR background checks and employment verification in the medical field (preferred)



Training

• Credential Stream credentialing software (preferred)