Job description:
Physician Credentialing Specialist
Job Overview
We are seeking a detail-oriented and experienced Physician Credentialing Specialist to support our team at a high-volume Ambulatory Surgery Center (ASC). This role is responsible for overseeing and maintaining all aspects of the credentialing and recredentialing processes for providers. The ideal candidate will have a minimum of 3 years of credentialing experience, preferably in a surgery center or hospital setting, and a thorough understanding of regulatory standards and compliance requirements.
Key Responsibilities Credentialing & Compliance:
- Manage the full credentialing and recredentialing process for all providers practicing at the surgery center.
- Conduct and document primary source verifications including, but not limited to:
- State medical licenses
- DEA and CDS registrations
- Board certifications
- Medical education and training
- Work history and malpractice history
- NPDB (National Practitioner Data Bank) reports
- OIG and SAM exclusion checks
- Identify and resolve discrepancies, incomplete information, or expired credentials and ensure timely follow-up.
- Maintain compliance with medical staff bylaws, AAAHC standards, CMS, and applicable state and federal laws.
Data Management & Reporting:
- Maintain up-to-date and accurate provider records in credentialing software and internal databases.
- Track expiration dates and ensure timely renewal of licenses, certifications, and malpractice coverage.
- Generate reports related to credentialing status, expirables, and compliance audits.
Administrative Support:
- Collaborate directly with the Administrator to ensure credentialing files and reporting meet regulatory and accreditation requirements.
- Support the Medical Staff Office and assist with audits, surveys, and day-to-day credentialing functions.
Communication & Confidentiality:
- Respond to internal and external inquiries regarding credentialing requirements and provider status.
- Communicate clearly with providers via email or call to obtain missing information or updates to their credentials.
- Maintain strict confidentiality of provider and patient information in compliance with HIPAA and organizational policy.
Additional Duties:
- Adhere to all ambulatory surgery center policies, including:
- Attendance: Arrives on time, uses timekeeping tools accurately, and requests time off appropriately.
- Professional Conduct: Demonstrates respectful behavior and complies with rules of conduct.
- HIPAA Compliance: Maintains the privacy of all protected health information.
- Perform other tasks as assigned by the Administrator.
Qualifications:
- Minimum of 3 years credentialing experience required, ideally in a medical, an ambulatory surgery center or hospital setting.
- Knowledge of credentialing regulations and processes including primary source verification standards for New jersey and New York.
- Familiarity with AAAHC, CMS, and state licensure regulations.
- Strong organizational skills and attention to detail.
- Excellent communication and time management skills.
- Proficiency in credentialing software and Microsoft Office Suite.
- Ability to commute.
Job Type: Full-time
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Work Location: In person
Pay: $22.00 - $24.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Application Question(s):
- How many years of physician credentialing experience do you have?
- Have you personally handled physician credentialing from application through approval?
- Are you comfortable independently managing multiple providers and tracking credential expirations and recredentialing deadlines?
Work Location: In person
