Human Resources Credentialing Specialist

The HR Credentialing Specialist is responsible for managing all aspects of the medical provider credentialing and re-credentialing processes within the ASC. This includes verifying licenses, certifications, and other qualifications for all medical staff, including physicians, nurses, and allied health professionals. This role ensures full compliance with federal and state regulations, as well as standards set by accrediting bodies like The NYC Department of Health, ACHC, or AAAHC. The specialist will maintain provider databases, manage deadlines, and communicate with providers and external organizations to ensure all credentials remain current and accurate.

Essential duties and responsibilities

• Credentialing and verification:
• Process initial and re-credentialing applications for all medical providers.
• Conduct thorough primary source verification of all provider documents, including education, training, licensure, board certifications, work history, and malpractice insurance.
• Perform and review background checks, including querying the National Practitioner Data Bank (NPDB) and Office of Inspector General (OIG) Exclusion List, et al.
• Database management and record-keeping:
• Maintain accurate and up-to-date provider information in the credentialing software and internal databases.
• Track expiration dates for all provider licenses, certifications, DEA certificates, and malpractice insurance, and initiate renewal workflows proactively.
• Maintain comprehensive digital and physical files for all credentialing documentation, ensuring confidentiality.
• Compliance and auditing:
• Ensure the ASC remains compliant with all federal and state laws regarding provider qualifications and privileging.
• Help prepare for and participate in internal and external audits from accrediting bodies (ACHC or AAAHC) and regulatory agencies (NYCDOH).
• Stay informed of changes to healthcare laws, regulations, and industry standards.
• Communication and coordination:
• Serve as a point of contact for providers, communicating clearly and professionally to gather missing information or clarify discrepancies.
• Coordinate with the billing and revenue cycle team to ensure providers are enrolled with insurance payers.
• Work with the ASC's Credentialing Committee, including preparing files and presenting information for review and approval.

Qualifications

• Education: High school diploma or GED required; an Associate's or Bachelor's degree in a related field is preferred.
• Experience: 3 years of experience in an Ambulatory Surgery Center, Article 28, medical office, hospital, or managed care setting, with a focus on provider credentialing. Experience in an ASC is preferred.
• Certifications: Professional certification, such as Certified Provider Credentialing Specialist (CPCS) from the National Association Medical Staff Services (NAMSS), is preferred.

Required skills and abilities

• Exceptional attention to detail and accuracy.
• Strong organizational and time-management skills with the ability to manage multiple deadlines.
• Excellent written and verbal communication skills.
• High degree of discretion in handling confidential and sensitive information.
• Proficiency with credentialing software, Microsoft Office Suite (Word, Excel), and database management.
• Ability to work independently and as part of a team.
• Resourceful and proactive in resolving issues.

Job Type: Part-time

Pay: From $25.00 per hour

Expected hours: 20 – 30 per week

Work Location: In person