Credentialing and Reappointment Specialist

Job Description

Job Description

The Credentialing and Reappointment Specialist is responsible for managing the complete credentialing, recredentialing, and privileging process for radiologists and advanced practice providers affiliated with our hospital-based radiology group. This position ensures that all providers meet hospital medical staff bylaws, payer participation requirements, and regulatory standards. The role involves close coordination with hospitals, imaging centers, and payers to ensure timely onboarding, reappointment, and maintenance of active privileges and payer enrollments.

Qualifications

• Education: Associate degree in healthcare administration, business, or related field required; bachelor’s degree preferred.
• Experience:
  • Minimum 2–3 years of credentialing experience in a hospital, radiology group, or managed care environment.
  • Experience with hospital-based privileging and payer enrollment strongly preferred.
• Certification: CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional Medical Services Management) preferred or required within 12 months of hire.
• Knowledge & Skills:
  • trong understanding of hospital credentialing, privileging, and payer enrollment processes.
  • Familiarity with radiology subspecialties (e.g., interventional, neuroradiology, musculoskeletal) preferred.
  • Excellent organizational and time management skills with the ability to manage multiple deadlines.
  • Strong communication and interpersonal skills with providers, hospitals, and payers.
  • Proficient in Microsoft Office Suite and credentialing databases (e.g., Modio, Echo, Symplr, CAQH).

Role and Responsibilities

• Coordinate and process initial credentialing and reappointment applications for radiologists and advanced practice providers, ensuring accuracy and compliance with hospital, payer, and regulatory standards.
• Verify provider credentials including medical education, residencies, fellowships, board certifications, licenses, DEA, malpractice history, and hospital affiliations.
• Prepare and submit complete credentialing and privileging packets to hospital medical staff offices for review and approval.
• Maintain current and accurate provider files and data within internal databases and external systems (e.g., CAQH, NPPES, PECOS, payer portals, CVO platforms).
• Track and monitor expiring credentials such as state licenses, board certifications, DEA, malpractice coverage, and hospital privileges, ensuring timely renewals.
• Coordinate with hospitals to manage reappointment and privilege renewal cycles, ensuring compliance with each facility’s timelines and requirements.
• Assist with payer enrollment and re-enrollment applications for commercial, Medicare, and Medicaid plans.
• Work closely with provider recruiting, human resources, and operations teams to support seamless onboarding of new radiologists.
• Respond to verification requests and audits from hospitals, payers, or other entities.
• Maintain strict confidentiality and adhere to HIPAA, Joint Commission, NCQA, CMS, and state/federal credentialing standards.
• Identify process improvements and contribute to policy updates to enhance efficiency and compliance.

Work Environment

• Hybrid or remote work option available depending on organizational needs.
• Standard business hours with flexibility to accommodate hospital or organizational deadlines.
• Requires handling confidential provider information and maintaining high attention to detail