Credentialing and Medical Records Specialist

Multi-site coverage required

Department:

Medical Staff Services / Human Resources / Provider Enrollment / Compliance

Position Summary

The Credentialing Specialist is responsible for coordinating, processing, and maintaining all aspects of provider credentialing, recredentialing, licensure verification, and payer enrollment to ensure healthcare professionals meet all organizational, regulatory, state, federal, and payer requirements. This role supports medical records with all record requests and legal requests.

Essential Duties and Responsibilities

Coordinate the initial credentialing and recredentialing process for physicians, nurse practitioners, physician assistants, therapists, and allied health professionals.
Verify provider education, training, board certifications, work history, malpractice coverage, state licensure, DEA registration, and professional references through primary source verification.
Maintain accurate credentialing files and electronic databases for all licensed practitioners.
Monitor expiration dates for licenses, certifications, malpractice insurance, and other required credentials.
Ensure timely follow-up with providers regarding missing or expiring documentation.
Prepare and submit credentialing applications to hospitals, health plans, Medicare, Medicaid, and commercial insurance carriers.
Process provider privileging applications and assist with medical staff appointment documentation.
Track application status and resolve delays with regulatory agencies, payers, and accrediting bodies.
Prepare credentialing reports, audit logs, and provider status updates for leadership.
Assist with credentialing audits, surveys, and accreditation reviews.
Collaborate with Human Resources, Medical Staff Office, and Operations departments regarding provider onboarding.
Maintain confidentiality of provider and organizational information.
Identify opportunities for process improvement within credentialing workflows.
Review of all medical record requests
Coordinate with the facility for all medical requests for legal review
Organize and track all legal record requests

Required Qualifications

Minimum of 2 years of healthcare credentialing, provider enrollment, or medical staff services experience.
Knowledge of provider credentialing standards, payer enrollment, and healthcare regulatory compliance.
Strong knowledge of Point Click Care, NPDQ, Florida Board
Proficiency in Microsoft Office Suite, especially Excel and Word.
Excellent organizational, analytical, and follow-up skills.
Strong written and verbal communication abilities.
Ability to manage multiple deadlines in a fast-paced environment.
High level of accuracy and attention to detail.

Preferred Qualifications

Experience with medical staff credentialing.
Familiarity with AHCA, CMS, Joint Commission, or survey requirements.
Experience in skilled nursing, managed care, physician practice, or multi-site healthcare systems.

Core Competencies