Credentialing and Privileging Specialist

Medical Associates Plus; Augusta (GA); On-site; USD 55,000 - 75,000; Full time

Job summary

Medical Associates Plus in Augusta, Georgia, is seeking a Credentialing and Privileging Specialist responsible for supporting human resources operations and coordinating provider credentialing and privileging. The ideal candidate will have at least three years of HR experience, understanding of credentialing processes, and knowledge of relevant laws.

This role requires excellent organizational and communication skills to ensure high-quality service and confidentiality in healthcare operations. Candidates should have a Bachelor's degree in a related field.

Qualifications

• At least three years of experience in a human resources role.
• Understanding of federal, state, and local HR laws relevant to healthcare.
• Experience with healthcare operations and provider licensing.

Responsibilities

• Assist in development of employment contracts.
• Conduct compensation analyses to support equitable pay practices.
• Maintain accurate personnel records in compliance with laws.
• Submit credentialing applications to verification organizations.

Skills

Credentialing processes knowledge

Organizational skills

Communication skills

Problem-solving skills

Proficiency in Microsoft Office Suite

Education

Bachelor’s degree in business administration, Human Resources, Healthcare Administration, or a related field

Tools

HRIS systems

Credentialing software

Job description

The Credentialing and Privileging Specialist is responsible for supporting human resources operations and coordinating all aspects of provider credentialing and privileging. This role requires strong attention to detail, discretion, and a comprehensive understanding of HR practices, healthcare credentialing requirements, and regulatory compliance. The Specialist supports a culture of professionalism, confidentiality, and high-quality service to both internal and external stakeholders.

Responsibilities and Duties

Human Resources Responsibilities

• Assist in the development and administration of employment contracts and amendments.
• Conduct compensation and pay rate analyses to support equitable pay practices.
• Contribute to the review and improvement of high-level HR policies and procedures.
• Complete human resources projects and assignments as delegated by the HR Director.
• Maintain accurate and confidential personnel records in compliance with state and federal laws.
• Conduct internal audits of HR files according to the established audit schedule.
• Participate in Continuous Quality Improvement (CQI) activities and internal committees.
• Ensure strict confidentiality of employee and patient information in accordance with HIPAA and organizational policies.

Credentialing Responsibilities

• Maintain current documentation of provider licenses, DEA and NPI numbers; distribute updates to applicable sites.
• Complete and submit credentialing applications to credential verification organizations (e.g., PHN).
• Obtain and store active licensure and certification records for all providers.
• Prepare and submit provider enrollment applications for Medicare, Medicaid, and commercial payers.
• Coordinate and monitor re-credentialing processes for existing providers.
• Attend relevant training workshops to maintain credential knowledge.
• Coordinate licensure requirements and renewals for all licensed staff.
• Oversee internal credentialing processes, including physical exams, TB screenings (PPDs), and privileging paperwork.
• Gather, verify, and review required documentation for privileging requests.
• Prepare temporary privileges and submit them to the Chief Medical Officer (CMO) and Chief Executive Officer (CEO) for approval.
• Prepare and submit full credentialing and privileging packets to the Board of Directors (BOD) for approval.

Qualifications

Knowledge, Skills, and Abilities

• At least three (3) years of experience in a human resources role, with demonstrated responsibilities in credentialing and privileging preferred.
• Working knowledge of credentialing processes, provider enrollment, and privileging standards.
• Demonstrated understanding of federal, state, and local laws applicable to HR and healthcare operations (e.g., FLSA, HIPAA, EEOC, CMS).
• Experience working in or with a healthcare facility, including familiarity with provider licensing and payer enrollment requirements.
• Excellent organizational, communication, and problem‑solving skills.
• Ability to handle sensitive and confidential information with discretion and professionalism.
• Strong interpersonal skills and the ability to work effectively with individuals of diverse backgrounds.
• Proficiency in Microsoft Office Suite and HRIS systems; experience with credentialing software is a plus.

Education

• Bachelor’s degree in business administration, Human Resources, Healthcare Administration, or a related field required.

Physical Requirements

• Ability to perform essential job functions with or without reasonable accommodation.
• Must be able to sit or stand for extended periods and intermittently walk throughout the workday.
• Requires occasional bending, stooping, reaching, and lifting items up to 30 pounds.
• Manual dexterity required to operate standard office equipment, including a computer keyboard.
• Visual and auditory acuity must be sufficient to perform essential functions, including reading, writing, and verbal communication.
• Primary work is performed in an office environment.
• Requires regular interaction with diverse groups of individuals including staff, providers, vendors, and external organizations.
• Occasional evening or weekend hours may be required to meet operational deadlines or support special projects.
• Position requires the use of tact, discretion, and sound judgment daily.

Disclaimer

The above is intended to describe the job functions, the general supplemental functions and the essential requirements for the performance of this job. It is not to be construed as an exhaustive statement of supplemental duties, responsibilities, or non-essential requirements.

Medical Associates Plus is an Equal Opportunity Employer and does not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identity and/or expression, veteran status, basis of disability or any other federal, state or local protected class.