Credentialing Specialist IIThe Credentialing Specialist II is responsible for managing the end-to-end credentialing and privileging process for physicians across a multi-state hospital system. This mid-level role requires strong knowledge of regulatory requirements and the ability to work independently while ensuring compliance with state-specific regulations, accreditation standards, and organizational policies. The specialist collaborates with medical staff leadership, providers, and administrative teams to ensure timely and accurate credentialing operations.Key ResponsibilitiesManage full-cycle credentialing and recredentialing processes for physicians across multiple hospital locations and states to ensure compliance with payors.Perform thorough primary source verification of licensure, board certifications, education, training, work history, and malpractice coverageEnsure compliance with federal, state-specific, and accreditation standards (e.g., Joint Commission, NCQA, CMS) across all facilitiesMaintain and update provider credentialing files and databases with a high degree of accuracyMonitor and track expiration dates for licenses, certifications, DEA registrations, and privileges; ensure timely renewalsEnsure that both facility and provider are credentialed with all payors to ensure proper payment from the payor.Interpret and apply medical staff bylaws, rules, and regulations across multiple facilitiesServe as a liaison between providers, department leaders, and administrative teams to resolve credentialing issuesAssist with payer enrollment and revalidation for multiple states as neededParticipate in internal audits, regulatory surveys, and accreditation reviews; ensure readiness at all timesIdentify process improvement opportunities and support standardization across the health systemMaintain strict confidentiality and compliance with HIPAA and data security standardsKnowledge, Skills & AbilitiesStrong working knowledge of credentialing standards (Joint Commission, NCQA, CMS)Understanding of multi-state licensure requirements, credentialing variations, and regulatory complianceFamiliarity with medical staff bylaws and privileging processes across multiple facilitiesHigh attention to detail with strong organizational and time management skillsAbility to work independently and manage a high-volume workload with competing prioritiesStrong analytical and problem-solving skillsExcellent written and verbal communication skillsProficiency with credentialing software systems and Microsoft Office Suite (especially Excel)Ability to maintain professionalism and discretion when handling sensitive provider informationEDUCATION / EXPERIENCE Education:High school diploma or equivalent requiredAssociate's or Bachelor's degree in Healthcare Administration, Business Administration, or related field preferredExperience:3–5 years of credentialing experience in a hospital or multi-facility healthcare systemDemonstrated experience with physician credentialing and privileging requiredExperience working with multi-state licensure and regulatory requirements strongly preferredCertifications (Preferred):Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM)PHYSICAL DEMANDSProlonged periods of sitting and computer useAbility to lift up to 15 pounds occasionallyWORK CONDITIONSOn-site role within the corporate officeMay require occasional travel between facilities within the health systemRegular interaction with physicians, leadership, and administrative staffOccasional early morning or late afternoon meetings for medical staff committeesAdditional Information This role is critical in supporting a geographically diverse healthcare system by ensuring providers meet all credentialing and privileging standards across multiple states.
The Credentialing Specialist II helps maintain regulatory compliance, supports patient safety, and contributes to efficient provider onboarding and retention.