We are looking for a Credentialing Specialist to support a healthcare organization through a Contract assignment. This position focuses on reviewing documentation, coordinating verification activities, and helping maintain accurate provider or business records in a regulated environment. The role suits someone who can manage detailed information, communicate effectively with internal and external contacts, and apply strong analytical judgment in day-to-day work.
Responsibilities:
- Perform primary source verification (PSV) of healthcare provider credentials, including medical licenses, education, board certifications, work history, and other required qualifications.
- Contact primary sources, such as state licensing boards, educational institutions, and certification organizations, to validate provider credentials and qualifications.
- Verify provider information in accordance with The Joint Commission (TJC) and/or NCQA standards, organizational policies, and regulatory requirements.
- Review credentialing and recredentialing applications for completeness, accuracy, and required supporting documentation.
- Track expiring licenses, certifications, and other credentials to ensure providers remain compliant with established requirements.
- Maintain accurate provider credentialing files, databases, and documentation to support audits and accreditation reviews.
- Follow up on missing, expired, or discrepant information and coordinate with providers and internal credentialing teams to resolve issues.
- Ensure verification dates, results, and supporting documentation are properly recorded and maintained for compliance purposes.
- 1–2+ years of experience in provider credentialing, medical staff services, or healthcare administration.
- Hands-on experience completing Primary Source Verification (PSV) for The Joint Commission (TJC) and/or NCQA.
- Knowledge of provider licenses, board certifications, education verification, and credentialing compliance standards.
- Strong attention to detail, data entry accuracy, and documentation management.
- Ability to maintain confidential records and meet deadlines in a fast-paced healthcare environment.