Credentialing & Compliance Specialist chez undefined

Overview

The Credentialing & Compliance Specialist is responsible for the ongoing management, monitoring, and verification of credentials for medical, dental, behavioral health, human service, and educational staff. This position ensures that all credentialing, privileging, and compliance processes are conducted accurately, efficiently, and in accordance with organizational, state, and federal standards.

Reporting to the Director of Compliance, the incumbent is responsible for  maintaining readiness for audits and accreditation reviews, and in fostering a culture of quality and accountability throughout the organization.

The Role

Credentialing and Records Management

• Maintain and update credentialing files and databases for all licensed and contracted personnel in accordance with internal policies and confidentiality standards.
• Verify education, professional licensure, certifications, and work history through external databases, including the NPDB, OIG Exclusion List, AMA, and state licensing portals.
• Track and monitor expiration dates for licenses and certifications, ensuring timely renewals and compliance with regulatory requirements.
• Support the privileging and re-privileging process by preparing and reviewing necessary documentation in collaboration with other functions.

Compliance and Audit Support

• Partner with the Director of Compliance to sustain ongoing monitoring systems and monthly audit processes.
• Conduct follow-up and corrective actions based on audit findings.
• Ensure preparedness for external audits, accreditation reviews, and regulatory inspections.
• Maintain current knowledge of relevant legal requirements, accreditation standards, and compliance protocols.

Reporting and Communication

• Generate timely and accurate reports related to credentialing, verifications, and compliance activities for internal leadership and external agencies.
• Serve as a resource for staff and supervisors regarding credentialing requirements and compliance policies.
• Communicate professionally and confidentially with internal and external stakeholders.

Requirements 

• Associate’s degree required; Bachelor’s degree preferred.
• Minimum of one (1) year of relevant experience in credentialing, privileging, or healthcare administration.
• Demonstrated knowledge of healthcare regulations, compliance standards, and accreditation requirements.
• Proficiency in Microsoft Office applications and database management.
• Proven exceptional attention to detail and accuracy with strong organizational and time management skills.
• Excellent written and verbal communication skills.
• Ability to maintain confidentiality and exercise sound judgment.
• Preferred:  Certified Provider Credentialing Specialist (CPCS) designation.

About Family Centers:

Family Centers is a private, nonprofit organization offering health, education and human service program to children, adults and families in Fairfield County. Our team of 300 professionals and over 500+ trained volunteers collaborate to provide our communities with a wide range of responsive and innovative services. Through our comprehensive network of services, more than 23,000 children, adults, families and communities receive the care, encouragement and resources needed to realize their potential. 

Rewards:

Salary is commensurate with experience. Family Centers offers a comprehensive benefits package including generous paid time off, medical, dental, and vision coverage, tax-free spending accounts, disability, life and AD&D insurance, employee assistance and wellness programs, pet insurance, tuition assistance, and retirement savings.

Family Centers is consistently recognized as one of the Top Workplaces in Western Connecticut by Hearst Connecticut Media and holds a perfect 100 Encompass rating from Charity Navigator. We are proud partners of the United Way, Community Fund of Darien, and New Canaan Community Foundation, and accredited by NAEYC and The Joint Commission.

For more information and to apply, please visit http://www.familycenters.org/  or on our LinkedIn page

Family Centers is committed to providing equal employment opportunities to all applicants and employees as indicated in applicable federal and/or state laws.