Corporate Credentialing Specialist

Shriners Children's; United States; Remote; USD 55,000 - 75,000; Full time

Job summary

Shriners Children’s is seeking a Credentialing Specialist to coordinate credentialing and privileging for physicians and advanced practice professionals. You will review, analyze, and follow up credentialing applications, maintaining confidentiality and ensuring compliance with accrediting bodies.

Responsibilities include verification of credentials, handling escalations, and collaboration with Medical Staff Offices to meet deadlines and regulatory requirements.

Qualifications

• Experience in healthcare credentialing in a regulatory environment.
• Experience with MD Staff or a credentialing database.
• Accurate data entry and ability to navigate a translational database.
• Proficiency with Microsoft Office applications.
• Certification CPCS or CPMSM or equivalent, CPCS within 24 months if not certified.
• High school diploma or GED required.

Responsibilities

• Coordinate credentialing/privileging requests for SHC facilities and affiliate locations.
• Verify credentials and expirables; document communications and maintain records.
• Investigate discrepancies and adverse information to ensure compliance.
• Maintain confidentiality and data entry in credentialing databases.
• Collaborate with SHC Medical Staff Offices to ensure timely approvals and audits.
• Stay current with accreditation standards (TJC, NCQA) and state/federal regs.

Skills

Regulatory credentialing

MD Staff credentialing database

Data entry in translational database

Microsoft Office proficiency

Credentialing CPCS/CPMSM certification

High School Diploma

Education

High School Diploma/GED

Associates Degree in relevant field

Bachelor’s Degree in relevant field

Job description

Company Overview

Shriners Children’s is an organization that respects, supports, and values each other. Named as the 2025 best mid-sized employer by Forbes, we are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience define us as leaders in pediatric specialty care for our children and their families.

With 20+ hospitals, outpatient clinics, ambulatory care centers and outreach locations across the globe, we provide excellent care to children up to age 18 regardless of their family’s ability to pay or insurance status. Please click here to learn more about our locations.

Job Description

The Credentialing Specialist coordinates and organizes ongoing credentialing and privileging of physicians and advanced practice professionals. Responsible for reviewing, analyzing, and follow-up of credentialing and privileging applications, maintaining strict confidentiality. Ensures compliance with federal and state agencies, organizational policies, and accrediting and regulatory agencies.

Key Responsibilities

• Coordinates and organizes credentialing/privileging requests/modifications for an SHC facility and supports providers requesting privileges at affiliate locations. Ensures evidence of education, training, and experience to determine eligibility for requested privileges and membership.

• Verifies and documents credentials and expirables using acceptable verification sources to ensure compliance with accreditation and regulatory standards, as well as manages and documents all communication with providers and primary facilities to ensure notification of upcoming expirables. Keeps a record of all credentialing activities in the credentialing database to ensure files reflect current status.

• Recognizes, investigates, and validates discrepancies and adverse information obtained; obtains and evaluates practitioner sanctions, complaints, and adverse data to ensure compliance.

• Responsible for confidentiality and data entry, maintenance, and analysis of clinical provider information within database per established guidelines to ensure complete electronic credential file to support provider enrollment and delegation requirements.

• Collaborates credentialing, OPPE, FPPE, and privileging activities with SHC Medical Staff Offices to ensure timely approval process of governing bodies, participation in accreditation surveys and audits, to include verification of appropriate drug and criminal background screenings. Prioritizes workload to meet deadlines.

• Maintains current knowledge of accreditation standards (TJC, NCQA), state and federal regulations, as well as SHC medical staff bylaws, regulations, and procedural rules.

Required Qualifications

• Experience in a healthcare setting performing regulatory credentialing

• Experience with MD Staff or relevant credentialing database

• Data entry skills. Including the ability to navigate a translational database to enter and retrieve information.

• Competency in Microsoft Office applications

• Certified Provider Credentialing Specialist (CPCS), Certified Professional in Medical Services Management (CPMSM) or equivalent certification. If candidate is not currently certified, CPCS will be required within24months of hire, or upon eligibility

• High School Diploma/GED

Preferred Qualifications

• Associates Degree (A.A.) in relevant healthcare field

• Bachelor’s Degree (B.S., B.A., etc.) in relevant healthcare field

Compensation is determined based on years of relevant experience and departmental equity.