Credentialing Specialist

Description

The Credentialing Specialist coordinates credentialing, appointment, reappointment, and privileging processes for practitioners at Down East Community Hospital (DECH) and Calais Community Hospital (CCH). Responsibilities include maintaining accurate and confidential practitioner files, verifying credentials, monitoring requirements and deadlines, and ensuring compliance with Medical Staff Bylaws, organizational policies, and applicable regulatory and accreditation standards.

The Credentialing Specialist also coordinates and supports assigned Medical Staff and service meetings, including scheduling, agenda and material preparation, meeting minutes, and follow-up actions.

The position requires a high level of organization, attention to detail, independent judgment, confidentiality, and the ability to manage multiple credentialing files, deadlines, and priorities simultaneously. The Credentialing Specialist serves as a resource regarding credentialing and privileging processes and communicates outstanding requirements and potential compliance concerns to appropriate Medical Staff Services leadership.

ESSENTIAL JOB FUNCTIONS

· Coordinates credentialing, appointment, reappointment, and clinical privileging processes in accordance with Medical Staff Bylaws, Rules and Regulations, and organizational policies.

· Reviews credentialing and privileging applications for completeness and accuracy, follows up on outstanding documentation, and maintains accurate, complete, and confidential practitioner credentialing and privileging files and electronic records.

· Conducts and documents primary-source verification of practitioner credentials, including licensure, education, training, board certification, professional history, and other required credentials.

· Monitors practitioner licenses, certifications, insurance coverage, and other credentialing requirements and tracks applicable expiration dates.

· Collaborates with practitioners, department and service leaders, Medical Staff leadership, administration, CVOs, and other departments to obtain required documentation and resolve credentialing or privileging issues.

· Coordinates Medical Staff committee and service meetings, including scheduling, agenda preparation, meeting materials, minutes, and follow-up actions.

· Monitors credentialing and privileging activities for compliance with CMS, state, accreditation, and organizational requirements.

· Performs other duties as assigned that are relevant to the position and department.

· Maintains reliable attendance and punctuality; performs duties safely and in accordance with organizational policies, procedures, safety standards, and Code of Conduct.

Requirements

· High school diploma or equivalent required; Associate's or Bachelor's degree in healthcare administration, business administration, or a related field preferred.

· One (1) year of experience in medical staff services, provider credentialing, healthcare administration, or a related healthcare setting preferred.

· Knowledge of practitioner credentialing, privileging, appointment/reappointment, and regulatory requirements preferred.

· Strong organizational and time-management skills with demonstrated ability to manage multiple priorities and deadlines.

· Strong attention to detail and ability to identify discrepancies or missing information in credentialing documentation.

· Ability to maintain strict confidentiality and appropriately handle sensitive practitioner and organizational information.

· Strong written and verbal communication skills.

· Ability to work independently while collaborating effectively with practitioners, Medical Staff leadership, administration, and other departments.

· Proficiency with Microsoft Office and electronic credentialing/database systems preferred.