Credentialing & Privileges Specialist

Michigan Medicine; Ann Arbor (MI); Hybrid; USD 64,000 - 90,000; Full time

Job summary

Michigan Medicine seeks a credentialing specialist to manage credentialing, recredentialing, license verification, and privileging with independent decision-making authority. You will ensure regulatory readiness by aligning with CMS, TJC, NCQA, ACHC, URAC standards and maintain data integrity across the provider systems.

The role requires meticulous evaluation of applications, primary source verification, and communication with clinical departments while supporting continuous improvement

Qualifications

• Bachelor's degree or equivalent combination of education and experience.
• Knowledge of accreditation and regulatory requirements for credentialing and privileging.
• 1-2 years experience in a credentialing role.
• Continuous Healthcare Improvement training within 3 months of hire.
• Demonstrated excellent interpersonal, problem-solving, and communication skills, both written and oral.
• Ability to make independent decisions on matters of significance using analytical skills and sound judgment.
• Excellent organizational and multi-tasking skills.
• Ability to work under pressure in a fast-paced environment, with strong time management skills.
• Demonstrated ability to work independently with a positive attitude.

Responsibilities

• Completes evaluation of applications to determine initial eligibility for membership/participation.
• Identifies red flags during credentialing and privileging with authority to halt the process and resolve issues.
• Conducts primary source verification for credentialing and privileging.
• Implements process improvement ideas using continuous improvement tools within regulatory requirements.
• Interprets and disseminates policies and procedures related to credentialing and recredentialing.
• Prepares credentialing records to affirm regulatory and accreditation readiness.
• Maintains confidentiality of credential information and protects data integrity across IT systems.
• Manages expirables such as licenses and certifications to maintain compliance.
• Presents complex credentialing information to clinical departments and stakeholders.
• Responds to inquiries and complaints with initiative, judgment, and customer-service orientation.

Skills

Interpersonal skills

Communication skills

Analytical thinking

Independent decision-making

Organizational skills

Time management

Ability to work under pressure

Independent work

Education

Bachelor's degree or equivalent

CPCS certification

Continuous Healthcare Improvement training

Job description

Michigan Medicine seeks a credentialing specialist to manage credentialing, recredentialing, license verification, and privileging with independent decision-making authority. You will ensure regulatory readiness by aligning with CMS, TJC, NCQA, ACHC, URAC standards and maintain data integrity across the provider systems.

The role requires meticulous evaluation of applications, primary source verification, and communication with clinical departments while supporting continuous improvement