Credentialing Specialist

Job Title: Credentialing Specialist
Location: Summit, NJ 07901
Duration: 3+ Months (Possible Extension)

Pay Range: $30 - $35/hr. on W2

Schedule: 8:00 AM – 4:00 PM
 
Job Summary:
The Credentialing Specialist ensures that all healthcare providers (physicians, nurses, therapists, and allied health practitioners) meet regulatory, accreditation, and organizational requirements. The role involves verifying credentials, maintaining accurate records, and supporting compliance with federal, state, and organizational standards.
 
Key Responsibilities:

1. Verification of Credentials:
   • Confirm licenses, certifications, education, training, and board certifications
   • Verify malpractice history and work experience
2. Compliance and Regulatory Oversight:
   • Ensure providers meet requirements of regulatory agencies, hospitals, and insurance networks
   • Maintain compliance with standards from The Joint Commission (TJC), NCQA, and other regulatory bodies
3. Enrollment and Privileging:
   • Manage applications for provider enrollment with insurance payers
   • Support hospital privileging process to authorize providers to perform specific procedures
4. Record Maintenance:
   • Maintain accurate and up-to-date credential files
   • Track expiration dates for licenses, certifications, and re-credentialing timelines
5. Communication and Coordination:
   • Act as a liaison between providers, HR, medical staff offices, and payers
   • Prepare materials for Credentials Committee, MEC, and Board of Trustees meetings
   • Schedule, attend, and take minutes for site-based medical staff meetings
6. Database Management:
   • Maintain provider information in the Echo database, including education, training, experience, and licensure
   • Track license and certification expirations
   • Maintain confidentiality of all provider information
7. Other Duties:
   • Collect dues for site-based medical staff
   • Process initial and reappointment applications (125–200 quarterly)
   • Carry out additional duties as assigned

 
Required Qualifications:

• Knowledge of the credentialing process and standards
• Strong organizational skills and ability to manage multiple priorities
• Excellent verbal and written communication skills
• Ability to research, analyze, and synthesize data
• Ability to work independently and maintain confidentiality
• Proficient computer skills
• Ability to establish and maintain effective working relationships