Credentialing Specialist

Job Title: Credentialing Specialist
Location: Onsite- Summit, NJ
Duration: Around 2months W2 contract with high possibility of extesnion based on performance and business needs
Pay Range: $30 $36/hour (W2)
Shift Timing: 8:00 AM 4:00 PM EST

Job Summary
The Credentialing Specialist is responsible for managing the credentialing and re-credentialing process for healthcare providers, ensuring compliance with all regulatory, accreditation, and organizational standards. This role involves verifying provider qualifications, maintaining accurate credentialing records, and supporting medical staff governance activities.

Key Responsibilities
Credentialing & Verification

• Verify credentials of healthcare providers including physicians, nurses, and allied health professionals
• Confirm licensure, certifications, education, training, board certifications, and malpractice history
• Review and validate initial applications and reappointments (approximately 125200 quarterly)
• Maintain accurate provider records in the credentialing database (Echo system)

Compliance & Regulatory Oversight

• Ensure adherence to federal, state, and organizational credentialing requirements
• Maintain compliance with regulatory bodies such as The Joint Commission (TJC) and NCQA
• Ensure credentialing processes align with hospital bylaws and policies

Enrollment & Privileging

• Support provider enrollment with insurance payers for billing eligibility
• Manage hospital privileging processes for clinical practice authorization

Data Management & Reporting

• Maintain up-to-date credential files and track license/certification expirations
• Compile reports for Credentials Committee, MEC, and Board of Trustees meetings
• Ensure accuracy and confidentiality of all provider data

Administrative & Coordination Duties

• Coordinate medical staff department meetings; may include scheduling, attendance, and minute-taking
• Maintain provider data in online credentialing systems
• Process and manage medical staff dues when applicable
• Serve as liaison between providers, medical staff offices, HR, and external agencies
• Support additional credentialing-related tasks as assigned

Required Qualifications:

• High School Diploma or equivalent
• Prior experience in healthcare credentialing or medical staff services (required)
• Strong understanding of the credentialing process
• Excellent organizational and time-management skills
• Ability to handle multiple priorities efficiently
• Strong written and verbal communication skills
• Ability to research, analyze data, and maintain accuracy
• Proficiency in computer systems and databases
• Ability to work independently and collaboratively
• High level of professionalism and confidentiality