Medical Records and Credentialing Specialist

The Medical Records and Credentialing Specialist ensures the integrity, accuracy, and compliance of both medical records and credentialing processes. This position manages, organizes, and safeguards patient health records to ensure accuracy, accessibility, and compliance with healthcare regulations. The role supports clinical teams, billing departments, and legal requests by maintaining complete and secure documentation, while also overseeing staff credentialing and licensure compliance.

Job Duties:

• Process records requests, including verifying Release of Information (ROI), selecting appropriate documents, and ensuring compliance with HIPAA and organizational policies
• Maintain complete and accurate client records to support continuity of care, legal compliance, accreditation standards, and billing integrity
• Complete licensing, credentialing, and re-credentialing for all licensed and prospective staff
• Conduct proactive outreach to staff to guide them through the credentialing process
• Track and manage renewals for staff licenses, certifications, and registrations
• Serve as liaison to providers, departments, and external agencies for credentialing matters
• Maintain credentialing files for both active and terminated staff
• Ensure licensing records and credentialing files are organized, complete, and up to date
• Participate in process improvements to increase efficiency and compliance of records and credentialing workflows
• Perform other job-related duties as directed

Required Skills/Abilities:

• Proficient with electronic health records systems and Microsoft Office Suite
• Ability to track, monitor, and follow up on multiple tasks simultaneously
• Familiarity with Medicare, Medicaid, and commercial insurance credentialing protocols
• Understanding of HIPAA compliance and clinical documentation standards
• Strong communication skills with the ability to liaise effectively across multiple teams and stakeholders
• Awareness and sensitivity of our constituents and the populations served by employees
• Regular and predictable attendance, and promptness for work

Education and Experience:

• High school diploma or G.E.D. required, Associate’s or Bachelor’s degree in health administration, business, or related field preferre
• Three years of experience in medical records management, credentialing, or healthcare administration is required
• Experience with electronic health records (EHR) and/or document management system(s) required
• Non-profit experience is preferred but not required