Credential Specialist

POSITION SUMMARY:

The Credentialing Specialist is responsible for managing and maintaining credentialing, licensing, and certification processes for employees in accordance with internal policies, industry regulations, and accreditation standards. This position ensures that all required documentation is up to date and compliant with regulatory and contractual obligations.

ESSENTIAL DUTIES AND RESPONSIBILITIES: Listed below you will find essential duties and responsibilities to successfully perform this job. Reasonable accommodation will be granted, as necessary to perform the essential duties and function of this position.

• Maintain and track licensure, certifications, and credentials for all applicable staff, ensuring timely renewals and compliance with federal, state, and organizational requirements.
• Verify professional qualifications including education, training, certifications, and work history for new hires and current employees.
• Process initial credentialing and recredentialing applications in alignment with payer, regulatory, and internal standards.
• Collaborate with hiring managers and HR staff to ensure credential requirements are met before employment or assignment.
• Monitor expiration dates and send timely reminders to employees and supervisors regarding upcoming renewals.
• Maintain and update credentialing files, digital databases, and documentation logs in accordance with policy and audit readiness.
• Respond to requests for verification from regulatory bodies, insurance plans, and accreditation agencies.
• Ensure credentialing processes adhere to applicable guidelines from organizations such as The Joint Commission, NCQA, and CMS.
• Participate in audits, surveys, and inspections by preparing necessary documentation and reports.
• Support onboarding by verifying eligibility to work in credentialed roles and ensuring proper documentation is in place.
• Assist in maintaining HRIS or credentialing software systems and generate compliance reports as needed.
• Stay current on changes in licensing and certification requirements relevant to the workforce.
• Maintain confidentiality of employee information in accordance with HIPAA and organizational policies.
• Coordinate and schedule basic life support training
• Assign, monitor and track employee training to ensure compliance with employment and credential policies.
• Participate in audit, compliance, workforce development and employee engagement initiatives.    
• Perform other duties as assigned by management.

The requirements listed below are representative of the knowledge, skill, and/or ability required for this position.

• EDUCATION & EXPERIENCE
  • Bachelor's degree or higher in human resource, business administration or related fields
  • One year of experience working in credentialing, compliance, or human resources
  • One year of experience working in healthcare or community-based organization preferred

• SKILLS & KNOWLEDGE

• Knowledge of credentialing standards, state licensing requirements, and regulatory guidelines.
• Demonstrated excellence in written and verbal communication, with the ability to engage effectively with employees, management, and stakeholders across all levels.
• Proven ability to build strong