Senior Medical Staff Credentialing Specialist

Atlantic Health; Pompton Lakes (NJ); On-site; USD 70,000 - 110,000; Full time

Job summary

Atlantic Health is seeking a Credentialing & Privileging professional to determine eligibility for Medical Staff and Allied Health membership and/or clinical privileges. You will perform complex primary source verification, maintain compliance with Joint Commission, CMS, and NCQA standards, and uphold data integrity and timely processing.

You will engage with leadership, providers, and interdisciplinary teams to resolve issues, support decision-making, and drive continuous improvement across

Qualifications

• High School Diploma required.
• Bachelor's Degree preferred.
• 3 years credentialing experience in a hospital or healthcare setting.
• Strong knowledge of Joint Commission, CMS, and NCQA standards.
• Demonstrated ability to analyze complex information, exercise sound judgment, and manage competing priorities.
• CPCS or CPMSM preferred.

Responsibilities

• Conducts initial and recredentialing primary source verification of education, training, licensure, work history, affiliations, malpractice history, references, and other by-laws requirements.
• Identifies, investigates, and resolves discrepancies or adverse findings to support informed decision-making by medical staff leadership and committees.
• Processes clinical privilege requests in alignment with established criteria.
• Manages credentialing workflows to ensure compliance with Joint Commission, CMS, and NCQA standards and timelines.
• Monitors file progression through review stages, ensuring completeness and audit readiness.
• Liaises with physicians and providers to communicate status and obtain documentation.
• Provides guidance on bylaws and credentialing requirements and responds to verification inquiries.
• Independently manages productivity and quality metrics and participates in process improvements.

Skills

Credentialing

Regulatory knowledge

Analytical thinking

Stakeholder communication

Education

High School Diploma

Bachelor's Degree preferred

Job description

Atlantic Health is seeking a Credentialing & Privileging professional to determine eligibility for Medical Staff and Allied Health membership and/or clinical privileges. You will perform complex primary source verification, maintain compliance with Joint Commission, CMS, and NCQA standards, and uphold data integrity and timely processing.

You will engage with leadership, providers, and interdisciplinary teams to resolve issues, support decision-making, and drive continuous improvement across