Credentialing and Privileging Specialist

Kids for the Future; Augusta (GA); On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Competitive salary

Employer-paid insurance

401k with employer match

Dental & Vision insurance

Paid time off

Job summary

Christ Community Health Services Augusta is seeking a Credentialing and Privileging Specialist to ensure clinical staff maintain licenses, certifications and privileges in compliance with HRSA and FQHC standards. You will manage credentialing and renewals, maintain documentation, and verify qualifications for new and existing staff.

The role reports to the Credentialing & Privileging Manager in Administration and Management, with responsibilities across CMS regulations, CAQH, payer portals, and

Qualifications

• At least three years of experience as professional support in health care, preferably in the medical staff services field (Required).
• Two years of experience in credentialing, privileging, enrollment or similar healthcare professional verification and organization’s accreditation processes (Preferred).
• Certified Provider Credentialing Specialist (CPCS), Certified Professional Medical Services Management (CPMSM) or Certified Provider Enrollment Specialist (CPES) (Preferred).
• Proficiency in using CredentialStream (VerityStream) (Preferred).
• Knowledgeable in CMS regulations and state boards.

Responsibilities

• Maintains compliance with regulatory and accrediting institutions with HRSA requirements for FQHCs.
• Monitors staff credentials and privileges and works with management to ensure continuous compliance.
• Develops, maintains, and utilizes tools to ensure compliance including electronic platforms.
• Supports and works with the insurance credentialing team to ensure efficient credentialing.
• Assists with Risk Management projects as needed.

Skills

CMS regulations

CAQH & payer portals

Credentialing workflows

Adobe / FoxIt PDF

MS Office

Attention to detail

Time management

Communication skills

Teamwork

Education

Three years healthcare staff support experience

Credentialing experience (2 yrs)

CPCS/CPMSM/CPES preferred

CredentialStream (VerityStream) proficiency

Tools

CredentialStream (VerityStream)

Microsoft Office

Adobe / FoxIt PDF

Job description

• Job Category Faith Based Health Care, Full Time, Administration
• Industry FQHC, Credentialing and Privileging, Regulatory Compliance
• Employee Type FT Exempt

Contact information

Description

Job Title: Credentialing and Privileging Specialist

Supervisor’s Title: Credentialing & Privileging Manager

Department: Administration and Management

FLSA Status: Exempt

UDS Category: Management and Support Personnel

Pay Category: Adm-1b

Employment Type: Full Time

Position Summary:

The Credentialing Specialist ensures clinical staff maintain the licenses, certifications, and privileges required to practice legally and in compliance with organizational standards. This role exists to manage credentialing and renewal processes, maintain accurate documentation, and verify qualifications for new and existing staff. By overseeing these activities, the position supports regulatory compliance, patient safety, and operational readiness.

Supervisory Responsibilities:

None

Essential Functions:

Maintains compliance with all regulatory and accrediting institutions with particular attention to internal policies, state laws, and the Health Services and Resource Administration (HRSA) requirements for Federally Qualified Health Centers (FQHCs)

Monitors staff credentials and privileges and work with management to ensure continuous compliance

Develops, maintains, and utilizes tools to ensure compliance including electronic platforms

Supports and works with the insurance credentialing team to ensure efficient insurance credentialing

Assists with Risk Management projects as needed

Abilities:

Eager and able to embody the Mission, Vision, and Core Values of CCH

Able and willing to demonstrate love, compassion, and genuine care when interacting with others

Ability to work as part of a team with excellent interpersonal skills

Possess a high level of self-motivation and energy, and work with minimal supervision

Fosters working relationships with senior leadership and management

Ability to support multiple team members and projects simultaneously and prioritize

Skills:

Knowledgeable in Centers for Medicare & Medicaid Services (CMS) regulations

Strong working knowledge of state boards, CAQH, payer portals, and credentialing workflows

Proficiency in Adobe and/or FoxIt PDF as well as the Microsoft Office Suite which includes Word, Excel, PowerPoint, and Outlook

Analytical skills to receive, assemble and report on data records

Extremely attentive to details

High organizational and time management skills

Highly developed oral and written communication skills

Education and Experience:

At least three years of experience as professional support in health care, preferably in the medical staff services field (Required)

Two years of experience in credentialing, privileging, enrollment or similar healthcare professional verification and organization’s accreditation processes (Preferred)

Certified Provider Credentialing Specialist (CPCS), Certified Professional Medical Services Management (CPMSM) or Certified Provider Enrollment Specialist (CPES) (Preferred)

Proficiency in using CredentialStream (VerityStream) (Preferred)

Work Conditions:

Rarely

(0-12%)

Occasionally

(13-33%)

Frequently

(34-66%)

Regularly

(67-100%)

Office: normal working conditions with the absence of disagreeable elements

X

Clinical: exposure to bodily fluids, bloodborne pathogens, & infectious diseases

X

Remote: work from home or location outside a central office

X

Outdoor/External: exposure to weather conditions & elements such as dirt, dust, oil, smoke, fumes, water

X

Extended hours: work performed beyond/outside operating hours

X

Travel required: use of a vehicle or other mode of transportation to complete tasks beyond arrival and departure to/from work

X

Physical Requirements:

Rarely

(0-12%)

Occasionally

(13-33%)

Frequently

(34-66%)

Regularly

(67-100%)

Seeing: Must be able to read documents and use computer

X

Hearing: Must be able to hear well enough to communicate with coworkers

X

Standing/Walking

X

Climbing/Stooping/Kneeling

X

Lifting/Pushing/Pulling: at least 15 pounds at a time

X

Sitting: prolonged periods of sitting

X

Fingering/Grasping/Feeling: Must be able to write, type, and use phone system

X

Attire:

Clinical/Scrubs

Maintenance/Trade

Business Casual

X

Note: The statements herein are intended to describe the general nature and level of work being performed by employees and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified. Furthermore, they do not establish a contract for employment and are subject to change at the discretion of the employer.

Summary

Company Background:
Our Mission:To proclaim Jesus Christ as Lord and to demonstrate His love by providing affordable, quality primary health care to the underserved.
Our Vision:In response to God’s grace, we desire to be a part of the redemptive work of Christ to the economically, socially, and spiritually impoverished communities of Augusta, Georgia.
About:Christ Community Health Services Augusta (CCH) is a rapidly growing, primary care health clinic and a community and faith-based 501 (c) (3) organization serving families in a ten-county region between Georgia and South Carolina.

As our patient population continues to grow throughout the greater Augusta area, we are in search of a caring and competent team members to join our team! Our four clinics (five, including dental) are strategically located in urban Augusta neighborhoods, providing local access to affordable care for patients who face medical, economic and transportation hardships. As a federally qualified health center and certified patient-centered medical home, we accept patients with no insurance, Medicare, Medicaid and most commercial insurance plans.
Our services include:

• Adult and Pediatric Primary Care
• Integrated Behavioral Health
• Family Dentistry
• Physical Therapy
• HIV/Chronic Disease Care Management
• Prescription Assistance
• Specialty Referrals

Christ Community Health aims to share Christ’s love through healing of the body, mind, and soul. Working at Christ Community, you’ll find community, vocational purpose, and a place to grow in the health care field.

What Christ Community has to offer:

• a competitive salary
• employer-paid medical, life, short-term disability, and long-term disability insurance
• available 401k plan with employer matching
• dental and vision insurance
• paid time off
• paid holidays
• flexible spending accounts
• employee care credit
• uniform allowances
• tuition assistance
• and more
• qualified employer under HRSA-funded loan repayment and Public Service Loan Forgiveness (PSLF) program

Christ Community Health Services Augusta Inc. is an Equal Opportunity Employer and does not discriminate on the basis of race, sex, color, age, national origin, marital status, disability, veteran status, sexual orientation, gender identity or any other federal, state, or local protected class.