Physician Services Credentialing Specialist

Job Description

Job Description

The Physician Services Credentialing Specialist plays a vital role in ensuring that all physicians maintain active status internally, with state boards, in Interstate compact license database, and or within client required credentialing process. This position may be assigned responsibility for processing initial credentialing applications, reappointments, renewals and provider enrollments while coordinating with physicians and cross departmental teams. This role ensures accuracy, compliance, and efficiency throughout all processes to support operational excellence.

Job Functions

• Process initial credentialing applications for new physicians
• Gather and verify required documentation, such as education, work history, licenses, certifications, malpractice insurance, and references
• Assist physicians in obtaining state medical licenses, hospital privileges, and provider enrollments
• Coordinate fingerprinting requirements for state medical boards
• Maintain clear and consistent communication with physicians and internal departments regarding the status of credentialing
• Identify and escalate issues or delays in the credentialing process
• Manage and process reappointment applications for all physicians
• Track and monitor physician credentialing renewal or reappointment dates to ensure compliance
• Maintain and update credentialing records, databases, and spreadsheets
• Ensure proper documentation and record-keeping of all credentialing activities
• Act as a liaison between physicians, medical boards, hospitals, and other credentialing bodies to obtain verifications and resolve issues
• Provide timely updates to relevant internal departments regarding physician status
• Utilize multiple communication methods, including phone, email, fax, and mail
• Support physician inquiries related to initial credentialing, renewals, and reappointments procedures
• Identify opportunities for improving processes and recommend best practices
• Remain current on industry regulations, credentialing requirements, and compliance standards
• Support the Physician Services department or other internal department with projects and assigned tasks

Preferred Talents

Qualifications Preferred