Credentialing and Privileging Specialist

This is a fully remote position, open to applicants in Alabama, +45 more states.

📋 Description

• Oversee and execute credentialing and privileging processes within the Credentialing and Privileging Office.

• Administer appointment, reappointment, and continuous verification activities for Medical Staff and Allied Health Professional Staff.

• Research and document practitioner credentials, encompassing background, training, and previous practice.

• Assess appointment and reappointment submissions for correctness and relevancy of information.

• Identify primary sources for verifications and record verification in practitioner files.

• Conduct follow-up and secondary source verification when required.

• Confirm that practitioners fulfill criteria for requested privileges and conduct focused professional practice evaluations, reappointments, status or privilege modifications, and temporary privileges.

• Analyze verifications for inconsistencies and probe into any questionable details.

• Inform supervisors and management of any adverse or dubious verification results.

• Compile scanned references of adverse or potentially adverse information for facility downloads when suitable.

• Record verification and inquiry findings in accordance with regulatory standards and entity agreements.

• Manage credentialing and privileging software to track queries, verification methods, privilege data, and associated activities.

• Maintain credential files for Medical Staff and Allied Health Professional Staff.

• Support the preparation of monthly Credentials Committee and Allied Health Professional Subcommittee agendas.

• Address customer inquiries and complaints.

• Execute other assigned or necessary duties.

⛳️ Requirements

• High School diploma or GED.

• 3 years of general office administration experience in a business, educational, or healthcare setting.

• Familiarity with credentialing and privileging standards from the Department of Health, Joint Commission, NCQA, URAC, and other governmental regulations.

• Preferred: Associate's Degree.

• Preferred: 3 years of experience in physician credentialing and privileging, medical education, hospital settings, health insurance, or managed care.

• Preferred: 1 year of experience in customer service.

• Preferred: Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM).

• Adherence to HIPAA, data security protocols, company policies, applicable laws, rules, regulations, and training requirements.

🏝️ Benefits

• Remote work opportunities.

• Competitive base pay range of $21.97–$34.39 per hour.

• Training and support for HIPAA and privacy/security policy compliance.

• Accessibility and accommodation support for applications.