Credential Specialist II
The Credentialing Specialist II is responsible for managing the end-to-end credentialing and privileging process for physicians across a multi-state hospital system. This mid-level role requires strong knowledge of regulatory requirements and the ability to work independently while ensuring compliance with state-specific regulations, accreditation standards, and organizational policies. The specialist collaborates with medical staff leadership, providers, and administrative teams to ensure timely and accurate credentialing operations.
Job Responsibilities/Duties:
Key Responsibilities
- Manage full-cycle credentialing and recredentialing processes for physicians across multiple hospital locations and states to ensure compliance with payors.
- Perform thorough primary source verification of licensure, board certifications, education, training, work history, and malpractice coverage
- Ensure compliance with federal, state-specific, and accreditation standards (e.g., Joint Commission, NCQA, CMS) across all facilities
- Maintain and update provider credentialing files and databases with a high degree of accuracy
- Monitor and track expiration dates for licenses, certifications, DEA registrations, and privileges; ensure timely renewals
- Ensure that both facility and provider are credentialed with all payors to ensure proper payment from the payor.
- Interpret and apply medical staff bylaws, rules, and regulations across multiple facilities
- Serve as a liaison between providers, department leaders, and administrative teams to resolve credentialing issues
- Assist with payer enrollment and revalidation for multiple states as needed
- Participate in internal audits, regulatory surveys, and accreditation reviews; ensure readiness at all times
- Identify process improvement opportunities and support standardization across the health system
- Maintain strict confidentiality and compliance with HIPAA and data security standards
- Strong working knowledge of credentialing standards (Joint Commission, NCQA, CMS)
- Understanding of multi-state licensure requirements, credentialing variations, and regulatory compliance
- Familiarity with medical staff bylaws and privileging processes across multiple facilities
- High attention to detail with strong organizational and time management skills
- Ability to work independently and manage a high-volume workload with competing priorities
- Strong analytical and problem-solving skills
- Excellent written and verbal communication skills
- Proficiency with credentialing software systems and Microsoft Office Suite (especially Excel)
- Ability to maintain professionalism and discretion when handling sensitive provider information
Education:
- High school diploma or equivalent required
- Associate’s or Bachelor’s degree in Healthcare Administration, Business Administration, or related field preferred
- 3–5 years of credentialing experience in a hospital or multi-facility healthcare system
- Demonstrated experience with physician credentialing and privileging required
- Experience working with multi-state licensure and regulatory requirements strongly preferred
- Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM)
- Prolonged periods of sitting and computer use
- Ability to lift up to 15 pounds occasionally
- On-site role within the corporate office
- May require occasional travel between facilities within the health system
- Regular interaction with physicians, leadership, and administrative staff
- Occasional early morning or late afternoon meetings for medical staff committees
This role is critical in supporting a geographically diverse healthcare system by ensuring providers meet all credentialing and privileging standards across multiple states. The Credentialing Specialist II helps maintain regulatory compliance, supports patient safety, and contributes to efficient provider onboarding and retention.
Recommended Jobs
Payments Product Manager - Vice President
Job Description You enjoy shaping the future of product innovation as a core leader, driving value for customers, guiding successful launches, and exceeding expectations. Join our dynamic te…
Staff Data Scientist
The Company\n\nPayPal has been revolutionizing commerce globally for more than 25 years. Creating innovative experiences that make moving money, selling, and shopping simple, personalized, and secure,…
QC Technician - Assurance
JOB DESCRIPTION PRIMARY DUTIES & RESPONSIBILITIES Apply quality assurance principles in a manufacturing environment to support compliance and prevention of defects Verify that in-proces…
IT Infrastructure Engineer II
About ShipMonk ShipMonk isn't just a 3PL; we're a growth partner for merchants . We provide cutting- edge technology and a network of owned and operated fulfillment centers that empower high-gr…
Medical Collector
Position: Medical Collections Specialist (Hospital/Insurance Follow-Up) Location: Remote (Must be based in San Antonio, TX) Pay Range: $24 – $26 / Hour Schedule: Monday – Friday, 7:30 AM –…
Assistant Construction Manager
Assistant Construction Manager – High Voltage Power Delivery Location: Travel / Project-Based (National) Employment Type: Contract Company Overview Our client is a recognized leader in …
Busperson Grotto
: A Busperson is responsible for assisting the servers in providing the highest quality service possible to guests while maintaining the highest standards of cleanliness and sanitation throughout the…
Pizza Maker
As a Cook for Pizza Inn, you will be responsible for learning the tasks associated with all of the following positions. For each of the positions, you will be expected to: ~Have a neat, clean app…
Traveling Assistant Superintendent
Job Description Job Description Salary: We are a growing Multi-Family General Contractor based in DFW that offers its employees competitive salaries and a generous benefits package. FTK C…
Vice President of Engineering
EHC is currently looking for a Vice President of Engineering for a client located in the south Houston, TX area. Job Summary: The Vice President of Engineering is a senior leadership role r…