Credentialing Specialist

970 Scotland Memorial Hospital, Inc; Laurinburg (NC); On-site; USD 52,000 - 68,000; Full time

Job summary

Scotland Memorial Hospital, Inc. is seeking a credentialing professional to manage credentialing and privileging in accordance with federal and state mandates and Scotland Healthcare policies.

You will track onboarding and reappointment processes, verify primary sources, and coordinate with physicians and staff to gather necessary materials for licensure and certification. You will safeguard credential files, monitor renewals, and ensure compliance with HIPAA, HCQIA, NCQA, CMS and Joint

Qualifications

• Experience managing credentialing workflows in healthcare.
• Proficient in primary source verification and data integrity.
• Familiar with HIPAA, NCQA, HCQIA, Joint Commission rules.

Responsibilities

• Perform credentialing and privileging per federal/state mandates and internal policy.
• Track and follow up on initial onboarding and reappointment applications.
• Coordinate with physicians and staff to collect materials for licensure and certification.
• Monitor credentials: licensure, board certification, hospital affiliation for renewals.
• Maintain privileged information with strict confidentiality and accuracy.
• Flag sanctioned providers and initiate corrective actions as needed.
• Query NPDB as required and ensure HCQIA compliance.
• Stay compliant with HIPAA, Joint Commission, NCQA and CMS regulations.

Skills

Credentialing

Primary Source Verification

Policy Compliance

HIPAA Compliance

Documentation

Team Coordination

Job description

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 database
3. Works with necessary individuals- including physicians, other professional staff and their office to acquire necessary materials and information for provider certification and licensure
4. 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 manner
6. Identifies sanctioned providers on state and federal disciplinary reports and initiates the requisite corrective processes to address cited violations
7. 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-wide
9. Serves as credentialing contact for employed physicians and advanced practice professionals. Monitors employed physicians and advanced practice professionals’ credentials including

Career at Scotland Health Care System

Careers At Scotland Health Care System, we’re proud to employ a team of dedicated professionals who embody the Scotland Way. Founded in 1946, Scotland Health Care System is a community-owned, not-for-profit organization serving Laurinburg, North Carolina. Our mission is simple yet powerful: to deliver safe, high-quality, compassionate, and sustainable health care to everyone in need. We offer a full spectrum of services—including inpatient, outpatient, and emergency care—along with specialized programs in cancer treatment, cardiac care, surgical services, and women’s health. Our culture is built on caring—for our patients and for our people. We believe that when we take exceptional care of our employees, they can provide exceptional care to our communities.

That’s why we offer: Competitive compensation Family-friendly benefits including Paid Parental Leave and On-Site Childcare Flexible scheduling Exclusive savings programs Career growth and advancement opportunities If you’re looking for more than just a job—if you want a meaningful career where you can make a difference—Scotland Health Care System is the place for you.

Scotland Health Care System in Laurinburg, North Carolina is proud to be the community's health care system. We are a community owned and controlled not-for-profit organization that includes Scotland Memorial Hospital, Scotland Physicians Network with sixteen medical practices, Scotland Regional Hospice (formerly Hospice of Scotland County), Scotland Family Counseling Center, and Scotland Memorial Foundation. Here at Scotland Health Care System, we understand that healthcare is evolving. Advances in medicine and strides in technology are providing local communities access to better healthcare. It is our desire to provide you the best care possible. Our staff will be here to help you and your loved ones when the need arises.

Our Beliefs About Our Future

To successfully accomplish our Mission and Vision our transformation must include creative and innovative changes in what we do and how we do it. We must change from a hospital and provider-centric model to a patient-centered, ambulatory model. There will be a continued focus on moving the industry to an increasingly ambulatory based delivery model focused on the health of the individual patient and the overall health of the population we serve. New payment models will incent us to better coordinate our patient’s care along the continuum of services. This includes both how our patients are treated and how their treatment information flows. New partners, arrangements, and competitors will emerge for us as a result of the new treatment and payment models. We will be strategically advantaged by coordinating access to a comprehensive continuum of care. Patients and their families will behave more like Consumers, expecting more Value, Convenience, and Access, in addition to caring and compassionate Service. Limited opportunities to pursue Smart Growth will necessitate us focusing our strategic efforts and resource allocation decisions.