Credentialing and Privileging Specialist

CaroMont Health; Gastonia (NC); On-site; USD 55,000 - 75,000; Full time

Job summary

CaroMont Health in Gastonia, NC seeks a Credentialing and Privileging Specialist to ensure timely, accurate, and compliant credentialing of Medical Staff providers and privileged practitioners.

Under supervision, you will handle initial appointments, reappointments, changes in privileges, and verification of credentials while maintaining up-to-date records in the credentialing database and aligning with bylaws and regulations.

Responsibilities

• Manage credentialing and privileging for assigned providers, including initial appointments, reappointments, changes in privileges, and other credentialing actions.
• Reviewing provider applications and supporting documentation for completeness, accuracy, and compliance.
• Obtaining primary source verification for credentials including licensure, education, certification, and prior affiliations.
• Monitoring provider credentialing files for outstanding requirements and follow-up with providers and other responsible parties to ensure timely completion.
• Maintaining accurate and current provider demographic, credentialing, and privileging information within electronic credentialing database.

Job description

Job Summary: The Credentialing and Privileging Specialist is responsible for the timely, accurate, and compliant credentialing and privileging of Medical Staff providers and privileged practitioners in accordance with Medical Staff Bylaws and organization policies, regulatory requirements, accreditation standards, and applicable federal and state regulations.

This position works under the supervision of the Manager of Medical Staff Services and interfaces with Medical Staff leaders and Senior Leadership. Essential functions and responsibilities include but are not limited to:

• Managing the credentialing and privileging process for assigned providers, including initial appointments, reappointments, changes in privileges, and other credentialing actions.
• Reviewing provider applications and supporting documentation for completeness, accuracy, and compliance.
• Obtaining primary source verification for credentials including but not limited to licensure, education, certification, and prior affiliations.
• Monitoring provider credentialing files for outstanding requirements and follow-up with providers and other responsible parties to ensure timely completion.
• Maintaining accurate and current provider demographic, credentialing, and privileging information within electronic credentialing database.