Credential Specialist
About AristaMD AristaMD is a technology-enabled clinical services organization that enables primary care providers to manage and sustainably deliver excellent specialty care, profitably. From our genesis as an eConsult provider, we have built longitudinal care delivery that is easily customized to meet the evolving needs of healthcare organizations. Our specialty care delivery and coordination services empower primary care organizations to deliver rapid access to high-quality specialty care, enhance population health management, and reduce costs. The Opportunity As a Credentialing Specialist at AristaMD, you will play a critical role in our mission to deliver rapid, high-quality specialty care. You will be responsible for ensuring that our network of healthcare providers meets the rigorous professional standards and regulatory criteria required to provide exceptional patient care. This role is at the heart of our operational efficiency, serving as the primary liaison between AristaMD, licensing boards, and external agencies.
Key Responsibilities
- End-to-End Credentialing: Lead the processing of initial applications and re-appointments for all providers, ensuring 100% accuracy and timeliness.
- Primary Source Verification (PSV): Conduct thorough verification of provider credentials (education, licensure, board certifications) in accordance with NCQA, URAC, and The Joint Commission standards.
- Strategic Database Management: Maintain the Medallion credentialing database to ensure real-time accuracy of provider profiles and proactively track expiration dates.
- Compliance & Audit Leadership: Prepare for internal and external audits, ensuring all provider files meet federal, state, and accreditation regulations.
- Sanction Screening & Enrollment: Conduct monthly queries of federal/state exclusion databases (OIG, SAM, NPDB) and manage PECOS/I&A applications for timely enrollment.
- Stakeholder Liaison: Act as a professional point of contact for providers and office managers to facilitate documentation and provide status updates.
- Governance & Policy: Maintain and update AristaMD’s Credentialing Policies and Procedures to remain aligned with current NCQA standards.
Required Qualifications
- Experience: Minimum of 2–3 years in healthcare credentialing, medical staff services, or provider enrollment.
- Regulatory Expertise: Deep proficiency in NCQA, CMS, and The Joint Commission guidelines.
- Technical Savvy: Advanced skills in Microsoft Office Suite and experience with specialized credentialing software (Medallion preferred).
- Education: High school diploma or GED required; Associate or Bachelor’s degree in Healthcare Administration preferred.
- Precision: Exceptional organizational skills with a high degree of accuracy in data entry and sensitive document review.
Preferred Skills & Certifications
- Professional Certification: CPCS or CPMSM via NAMSS is highly preferred.
- Communication: Strong verbal and written skills for interfacing with medical professionals and executive leadership.
- Discretion: Ability to handle confidential information with strict adherence to HIPAA regulations.
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