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jazzhr

Credential Specialist II

Exceptional Healthcare Inc.
Dallas, USA
Full-time
Mid Level
Onsite
Discovered 1 months ago

Full Job Posting

  • 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
  • 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

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