Credentialing and Privileging Specialist

Position Summary 

Reporting to the Chief Human Resources Officer, the Credentialing and Privileging Specialist ensures that all licensed independent practitioners and advanced practice providers, including physicians, nurse practitioners, physician assistants, dentists, behavioral health clinicians, and other clinicians, are properly onboarded, privileged, and credentialed before providing patient care. The specialist manages the full provider lifecycle: initial credentialing, privileging, re-credentialing, onboarding, and ongoing monitoring. The role supports compliance with HRSA Health Center Program requirements, FTCA deeming standards, accreditation standards, and payer requirements. The specialist works in close partnership with the Chief Medical Officer and clinical leadership, who holds authority over clinical privileging decisions, and reports credentialing and onboarding status to senior and executive leaders. 

Key Responsibilities 

Onboarding 

• Coordinate and track provider and clinical staff onboarding from offer acceptance through first day of patient care, in alignment with HR hiring and onboarding processes. 

• Partner with Talent Acquisition, Compliance, IT, Clinical Operations, Revenue Cycle, and site leadership to ensure all onboarding steps are completed. These include, for example, employment verification, background checks, health screenings and immunizations, required trainings, EHR access, badging, orientation, and competency validations. 

• Confirm that no provider begins independent patient care until credentialing, privileging, and onboarding requirements are fully met. 

• Maintain onboarding checklists, identify bottlenecks, and drive timely completion to support provider start dates. 

Credentialing and Re-credentialing 

• Process initial credentialing applications for all providers in accordance with organizational policies, HRSA requirements, and applicable accreditation standards. 

• Manage the re-credentialing cycle, ensuring every provider is re-credentialed and re-privileged on schedule (at least every two years for FTCA-covered providers, or per organizational policy and accreditation requirements). 

• DEA and state-controlled substance registrations, work history, malpractice history, and hospital affiliations or admitting arrangements. 

• Query the National Practitioner Data Bank (NPDB), OIG List of Excluded Individuals/Entities, SAM.gov, and state Medicaid and Medicare exclusion databases at appointment, at re-credentialing, and on a continuous or monthly basis. 

• Follow up on gaps, discrepancies, or adverse findings and escalate concerns promptly to the CHRO, CMO, and compliance leadership. 

• Maintain accurate, complete, and confidential credentialing and privileging files. 

Privileging 

• Coordinate the delineation of clinical privileges with the CMO and clinical leaders, based on training, experience, and demonstrated competence, aligned with the scope of services in the health center's HRSA-approved scope of project. 

• Prepare provider files for review and approval by the CMO, Credentialing Committee, and Governing Board (or per bylaws). 

• Track focused and ongoing professional practice evaluations (FPPE/OPPE), performance reviews, and peer review documentation required for re-privileging, obtaining clinical input from the CMO and designated peer reviewers. 

• Manage temporary privileges, ensuring proper documentation and timely close-out. 

FTCA and HRSA Compliance 

• Maintain credentialing and privileging files that meet FTCA deeming requirements and HRSA's Policy Information Notice (PIN) on credentialing and privileging. 

• Support the annual FTCA deeming application and renewal process, including provider data and documentation. 

• Assist with HRSA Operational Site Visits (OSV), audits, and corrective action plans related to credentialing, privileging, and onboarding. 

• Track compliance with applicable Joint Commission, AAAHC, or NCQA standards, as well as state and federal regulations. 

Monitoring and Tracking 

• Track expiration dates for licenses, certifications (e.g., BLS, ACLS), DEA registrations, malpractice or FTCA coverage, and other time-sensitive credentials, and send timely reminders to providers and managers. 

• Maintain a master tracking system across all sites and provider types, with proactive alerts for upcoming expirations and re-credentialing due dates. 

• Ensure providers are not scheduled for patient care when credentials have lapsed or are incomplete and escalate immediately when issues arise. 

Payer Enrollment 

• Submit and track provider enrollment and revalidation with Medicare, Medicaid, managed care organizations, and commercial payers. 

• Maintain CAQH profiles and coordinate with billing and revenue cycle teams to prevent delays and denials tied to enrollment. 

Reporting and Leadership Communication 

• Provide regular reports and dashboards to senior and executive leadership on: 

• Credentialing and re-credentialing status, including pending, overdue, and upcoming files 

• Onboarding completion and time-to-start metrics 

• Expiring credentials and compliance risks 

• Audit readiness and corrective actions 

• Turnaround times and trends tied to organizational growth 

• Present key findings and risks at leadership and committee meetings and recommend corrective actions. 

• Provide data to support workforce planning and recruitment as the organization expands. 

Process Improvement and Scalability 

• Develop and refine policies, procedures, workflows, and templates to support a growing provider base and new sites, in coordination with HR, the CMO, and Compliance. 

• Recommend and help implement technology solutions (e.g., MedTrainer, symplr, Modio, VerityStream), including integration with the HRIS, to automate tracking and reporting. 

• Stay current on HRSA, CMS, FTCA, and state regulatory changes, and update processes accordingly. 

Committee and Administrative Support 

• Prepare agendas, files, and minutes for the Credentialing Committee and related governance meetings. 

• Serve as the primary point of contact for providers, hiring managers, and external agencies on credentialing matters. 

Qualifications 

Required 

• Associate or bachelor's degree preferred; high school diploma or equivalent with relevant experience accepted. 

• 3+ years of experience in healthcare credentialing, medical staff services, or provider enrollment. 

• Working knowledge of primary source verification, credentialing standards, and healthcare regulations. 

• Proficiency with credentialing software, HRIS platforms, Excel, and Microsoft Office. 

• Strong organizational skills, with proven ability to manage high volumes and competing deadlines. 

• Excellent written and verbal communication skills, including the ability to present to senior leaders. 

• Commitment to confidentiality and discretion with peer review and personnel information. 

Preferred 

• Experience in an FQHC, community health center, or other ambulatory setting. 

• Familiarity with HRSA Health Center Program requirements, FTCA deeming, and PCMH or other accreditation standards. 

• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM), or willingness to obtain within 12-18 months. 

• Experience supporting multi-site organizations through rapid growth. 

• Experience coordinating onboarding with HR and building dashboards or executive reports. 

• Bilingual (English/Spanish or other languages relevant to our community) is a plus. 

Core Competencies 

• Accuracy, thoroughness, and accountability 

• Integrity and confidentiality 

• Ownership of deadlines and follow-through 

• Executive-level communication and reporting 

• Cross-functional collaboration, especially between HR and clinical leadership 

• Problem-solving and sound judgment 

• Adaptability in a fast-growing, regulated environment 

• Commitment to the FQHC mission of serving underserved communities 

Working Conditions 

• Primarily office-based, with hybrid or remote flexibility depending on organizational policy. 

• Occasional travel between sites. 

• Extended computer use and handling of sensitive documents. 

• Higher-intensity periods around HRSA reviews, FTCA deeming renewals, audits, and rapid hiring cycles.