Credentialing and Privileging Specialist (Healthcare)

Location: Working from home in Pennsylvania, United States

Company

hirify.global's Allegheny Health Network provides healthcare services through medical staff and allied health professional programs.

What you will do

• Review medical staff and allied health practitioner appointment and reappointment applications.
• Conduct and document primary-source, follow-up, and second-source credential verifications.
• Verify practitioner eligibility for requested privileges and support professional practice evaluations, status changes, and temporary privileges.
• Investigate discrepancies and escalate adverse or questionable verification results.
• Maintain credential files and tracking records in the credentialing and privileging software system.
• Assist with monthly Credentials Committee and Allied Health Professional Subcommittee agendas.

Requirements

• High school diploma or GED.
• Three years of general office administration experience in a business, education, or healthcare environment.
• Knowledge of credentialing and privileging requirements from the Department of Health, Joint Commission, NCQA, URAC, and other applicable authorities.
• Ability to work from Pennsylvania.
• Compliance with HIPAA, data security requirements, applicable laws, and company policies.

Nice to have

• Associate's degree.
• Three years of experience in physician credentialing and privileging, medical education, a hospital environment, health insurance, or managed care.
• One year of customer service experience.
• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification.

Culture & Benefits

• Work-from-home arrangement in Pennsylvania.
• Role operates within established ethical, legal, privacy, and information-security standards.
• Work involves protecting confidential customer, cardholder, and covered health information.