Credentialing Specialist

Scotland Health; Laurinburg (NC); On-site; USD 52,000 - 78,000; Full time

Job summary

Scotland Memorial Hospital in Laurinburg, NC seeks a Credentialing Specialist to manage the credentialing and privileging process for employed physicians and advanced practice professionals. The role ensures timely verification and compliance across state and federal mandates.

You will coordinate with physicians and staff, safeguard confidential information, and stay current with HIPAA, HCQIA, NCQA, and CMS regulations to support reliable credentialing operations.

Responsibilities

• Performs credentialing and privileging per federal/state mandates and Scotland Healthcare policy.
• Tracks physician applications/onboarding and reappointment; performs primary source verification.
• Collects materials from physicians and staff to support provider certification and licensure.
• Acts as credentialing contact for employed physicians and advanced practice professionals.
• Monitors credentials (licensure, board certification, hospital affiliation) for timely renewal.
• Identifies sanctioned providers on disciplinary reports and initiates corrective actions.
• Queries the National Practitioner Data Bank in HCQIA-compliant manner.
• Stays compliant with HIPAA, Joint Commission, HCQIA, NCQA, CMS requirements and relays changes.
• Maintains credentialing files with confidentiality and security standards.

Job description

## Credentialing SpecialistApply: Scotland Memorial Hospital - 500 Lauchwood Dr, Laurinburg, NC: Full time: Posted 30+ Days Ago: R232896**Department:**Scotland Memorial Hospital - Patient Financial Services**Status:**Full time**Shift:**1st (United States of America)**Schedule Details/Additional Information:****Job Description:**1.Performs the credentialing and privileging process in accordance with federal and state mandates as well as with criteria defined by Scotland Healthcare ‘s compliance policy, in a complete and accurate manner.2.Tracks and follows up on physicians initial application/onboarding processes and reappointment application by performing primary source verification, preparing agency correspondence, and tracking responses within the organizations database3.Works with necessary individuals- including physicians, other professional staff and their office to acquire necessary materials and information for provider certification and licensure4.Serves as credentialing contact for employed physicians and advanced practice professionals. Monitors employed physicians and advanced practice professionals’ credentials including, but not limited to state licensure, board certification, and hospital affiliation status for timely renewal and renewal support.5.Safeguards the integrity of privileged information and credential files in a professional, sensitive manner6.Identifies sanctioned providers on state and federal disciplinary reports and initiates the requisite corrective processes to address cited violations7.Quarries the Nation Practitioner Data Bank as needed, and does so in compliance with the Healthcare Quality Improvement Act (HCQIA)8.Remains complaint with and knowledgeable of rules and regulations set forth by HIPAA, Joint Commission, the HCQIA, the National Committee for Quality Assurance (NCQA), the Centers for Medicare and Medicaid Services, as well as state regulations and relays this information to the necessary parties to ensure ongoing compliance organization-wide9.Serves as credentialing contact for employed physicians and advanced practice professionals. Monitors employed physicians and advanced practice professionals’ credentials including