Senior Credentialing Specialist

Ardent Health is a leading provider of healthcare in communities across the country. With a focus on consumer-friendly processes and investments in innovative services and technologies, Ardent is passionate about making healthcare better and easier to access. We are driven by our purpose of caring for people: our patients, our communities and one another. Located in Brentwood, Tennessee, Ardent has earned a reputation as one of the industry’s strongest and most innovative healthcare systems. Our facilities and clinics are consistently recognized among healthcare’s best employers. We recognize each hospital and clinic is as unique as the community it serves. We strive to maintain strong community ties through advisory boards, contributions, charitable care, education and outreach. Ardent includes:

• 30 hospitals
• 280 sites of care
• 4,281 beds
• 24,000+ team members
• 8,200+ nurses
• 1,800+ aligned providers
• 5.8M annual provider encounters
• 421 medical residents

 Ardent makes considerable investments in people, technology, facilities, and communities, producing high quality care and extraordinary results. From newly constructed facilities and expanded services, to lifesaving technology and outstanding opportunities for employees, Ardent is committed to providing its hospitals and clinics the tools needed to succeed. We believe it is this mix of corporate support and local autonomy that equips our teams for success.  

 

Performs full primary source verification and file construction for initial credentialing and recredentialing across Ardent facilities and the managed care network. Serves as subject matter expert and lead reviewer for complex provider files. 

• →Conducts primary source verification of licensure, DEA registration, board certification, education and postgraduate training, work history, malpractice coverage and claims history, and hospital affiliations. 
• →Queries the NPDB and applicable exclusion and sanctions databases (OIG, SAM, state-level lists) and document results. 
• →Reviews high-risk and complex credentialing files as assigned or as needed when support is needed. 
• →Provides staff training and mentoring on credentialing standards and serves as subject matter expert when needed.  
• →Performs quality reviews of completed credentialing files and resolves outstanding issues or errors. 
• →Monitors data governance and identifies trends and opportunities for process improvement.  
• →Meets defined productivity and turnaround standards as determined by leadership.  
• →Maintains accurate, audit-ready documentation of every verification attempt and outcome. 

Job Requirements:

• 3+ years of experience with provider credentialing and primary source verification experience 
• Strong understanding of provider credentialing requirements 
• Knowledge of various credentialing regulatory and accreditation standards, including, but not limited to NCQA, URAC, TJC, CMS, state DOI, etc. 
• High attention to detail and demonstrated accuracy in high-volume work 
• Proficiency with credentialing software and standard office applications 

Preferred Job Requirements:

• CPCS certification, or eligibility with intent to certify 
• Experience in a hospital, health system, CVO, or managed care setting