Credentialing

Job Summary:

The Credentialing manages provider credentialing files, performs Primary Source Verifications (PSV), and ensures database accuracy. This role ensures all providers meet NCQA, regulatory, and internal standards for smooth onboarding without handling payer enrollment.

Key Responsibilities:

• Document Collection: Gather and review provider credentials (medical licenses, DEA, board certifications, malpractice coverage).
• Primary Source Verification (PSV): Verify credentials directly with state boards, medical schools, and training programs.
• Sanction Screenings: Run background checks via OIG, SAM, and NPDB databases.
• Tracking: Monitor and prompt providers for upcoming renewals (licenses, DEAs, certifications).
• Database & File Maintenance: Maintain clean, audit-ready digital files and accurate records in the credentialing database.

Key Tools & Skills:

• Verification Portals: State Boards, OIG, SAM.gov, NPDB, FSMB
• Software: Credentialing platforms , MS Excel/Word
• Standards: NCQA, Joint Commission (TJC), HIPAA