Details
Posted: 23-Apr-26
Location: Summit, New Jersey
Categories:
Operations
Lead Credentialing Specialist (Role will be based at Atlantic Health Overlook Medical Center in Summit NJ with travel expectations for other sites)
Purpose:
Participates in complex departmental activities to ensure quality in conducting, maintaining, and communicating the medical and allied health professional staff credentialing, privileging, and primary source verification process. Audits, measures performance, trains team, serves as a resource of the department, and collaborates with management to advance the quality of practitioners and patient safety of the facility. Assists with additional duties including coordination and review of department activities.
Essential Functions
30%
- Audits, analyzes, and monitors credentialing application/files processed by Credentialing Specialist staff to ensure appointments are processed in required timeframes, including all required primary source verifications and accompanying documentation, to ensure files meet regulatory requirements.
20%
- Documents and tracks performance statistics of the Credentialing Specialists application processing related to accuracy and communicates with the managers when issues are identified.
- Reviews statistics regarding performance measures and goals with management regularly and assists with identifying trends.
- Trains new and existing staff on how to process initial and/or reappointment/re-credentialing applications.
15%
- Determines practitioner eligibility for membership/participation or changes in status.
- Analyzes application and supporting documents for accuracy and completeness and informs the practitioner of the application status, including the need for any additional information or corrections.
- Obtains, researches, and evaluates information from primary sources to ensure compliance with accreditation and regulatory standards to validate accuracy of applications for one or more decision making bodies, including a thorough background investigation and primary source verification of all components of the application file, such as applicant's education and training, licensure, work history, hospital affiliation history, malpractice claims history, board certification status, criminal background, evaluation of health status, and peer recommendations.
- Recognizes, investigates, and validates discrepancies and adverse information obtained during the application process to ensure review and approval bodies have information needed to make informed credentialing decisions.
15%
- Reviews file for accuracy and completeness before submission.
- Routes the credentials files to the department chief/chair or designee for review and recommendation for membership and privileges.
- Coordinates expedited credentials committee and board approval process for credentials files being recommended by the departments.
- Coordinates emergency privilege requests for hospital privileges as needed.
- Prepares practitioners credentials files for presentation to the Atlantic Health's hospitals Committees and Board.
15%
- Assists the Credentialing Specialists with the National Practitioner Data Bank Continuous Query Renewals.
- Responds to inquiries from other healthcare organizations and interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
- Communicates the status of applicant files directly to providers and various department representatives, clients, and/or affiliates and coordinates efforts to obtain necessary information and/or documentation to ensure deadlines are met.
- Assists management with review and assessment of departmental functions and services to identify areas in need of review or improvement and implement changes as needed.
- Assists with various aspects of the credentialing expirables process, including but not limited to, the ongoing monitoring of sanctions, board certification status, and current malpractice coverage. Represents the Medical Staff Services Department for various initiatives, audits, and/or committee meetings as needed. Serves as the primary back up to all credentialing staff including the Credentialing Coordinator. Serves as a Team Peer Interviewer as needed.
5%
- Other duties as assigned.
Education
- Associates' degree in Business or Healthcare Administration or related field AND 3 years of experience in Medical Staff credentialing and/or payer enrollment functions required OR equivalent combination of education and experience.
Experience
- Proficiency with credentialing software systems to manage provider data, workflows, and documentation accurately and securely.
- This includes strong data entry and reporting skills, electronic document management, knowledge of compliance and HIPAA requirements, and proficiency with Microsoft Office tools.
- Experience troubleshooting system issues, adapting to software updates, and following electronic workflows and audit requirements is also preferred.
Knowledge, Skills and Abilities
- Fluent English language skills (verbal and written)
- Knowledge of and experience with Joint Commission, CMS, and NCQA Regulations related to medical staff services and Commercial Payers Credentialing
- Exceptional interpersonal and communication skills
- Ability to develop and maintain relationships with a variety of key stakeholders across the organization
Licenses/Certifications (Preferred)
- Certified Medical Professional Services Management (CPMSM)
- Certified Provider Credentialing Specialist (CPCS)
At Atlantic Health, our promise to our communities is; Anyone who enters one of our facilities will receive the highest quality care delivered at the right time, at the right place, and at the right cost. This commitment is also echoed in the respect, development and opportunities we give to our more than 22,000 team members. Headquarters in Morristown, New Jersey, we are one of the leading non-profit health care systems in the nation. Our facilities and sites of care include:
- Atlantic Health Morristown Medical Center, Morristown, NJ
- Atlantic Health Overlook Medical Center, Summit, NJ
- Atlantic Health Newton Medical Center, Newton, NJ
- Atlantic Health Chilton Medical Center, Pompton Plains, NJ
- Atlantic Health Hackettstown Medical Center, Hackettstown, NJ
- Atlantic Health Goryeb Children's Hospital, Morristown, NJ
- Atlantic Health CentraState Healthcare System, Freehold, NJ
- Atlantic Medical Group
- Atlantic Visiting Nurse
- Atlantic Mobile Health
- Atlantic Rehabilitation
We have more than 900 community-based healthcare providers affiliated through Atlantic Medical Group.
We have received awards and recognition for the services we have provided to our patients, team members and communities. Below are just a few of our accolades:
- Chosen for 17 years by Fortune as one of the magazine's "100 Best Companies to Work For."
- Atlantic Health Morristown and Atlantic Health Overlook Named by Newsweek as two of the "World's Best Hospitals" in 2026.
- Atlantic Health Morristown and Atlantic Health Overlook ranked within the top three hospitals in New Jersey by U.S. News & World Report's 2025-2026 Best Hospital rankings.
- Atlantic Health scored four "A" grades by The Leapfrog Group in its Fall 2025 Hospital Safety Grades, performance measures reflecting errors, accidents, injuries and injections, as well as systems hospitals have in place to prevent harm.
- Atlantic Health Morristown and Atlantic Health Overlook are New Jersey's only hospitals to be named among America's 50 Best hospitals by Healthgrades in 2026.
- Named by Becker's Healthcare as one of the "165 Top Places to Work in Healthcare - 2026.
- Atlantic Health Morristown, Atlantic Health Overlook, Atlantic Health Chilton and Atlantic Health Newton all Forbes Top Hospitals for 2026.
- Named by Newsweek as one of America's Greatest Workplaces for Inclusion & Diversity 2025.
- Atlantic Health rated LEVEL 9 - 2025 CHIME Digital Health Most Wired.
Atlantic Health offers a competitive and comprehensive Total Rewards package that supports the health, financial security, and well-being of all team members. Offerings vary based on role level (Team Member, Director, Executive). Below is a general summary, with role-specific enhancements highlighted:
Team Member Benefits
- Medical, Dental, Vision, Prescription Coverage (22.5 hours per week or above for full-time and part-time team members)
- Life & AD&D Insurance.
- Short-Term and Long-Term Disability (with options to supplement)
- 403(b) Retirement Plan: Employer match, additional non-elective contribution
- PTO & Paid Sick Leave
- Tuition Assistance, Advancement & Academic Advising
- Parental, Adoption, Surrogacy Leave
- Backup and On-Site Childcare
- Well-Being Rewards
- Employee Assistance Program (EAP)
- Fertility Benefits, Healthy Pregnancy Program
- Flexible Spending & Commuter Accounts
- Pet, Home & Auto, Identity Theft and Legal Insurance
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Note: In Compliance with the NJ Pay Transparency Act (effective Sunday, June 1, 2025), all job postings will include the hourly wage or salary (or a range), as well as this summary of benefits. Final compensation and benefit eligibility may vary by role and employment status and will be confirmed at the time of offer.
EEO STATEMENT
Atlantic Health, Inc. is an equal employment opportunity employer and federal contractor or subcontractor and therefore abides by applicable laws to protect applicants and employees from discrimination in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment, on the basis of race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, citizenship status, disability, age, genetics, or veteran
Atlantic Health System is at the forefront of medicine, setting standards for quality health care powered by a workforce of more than 18,000 team members and 4,800 affiliated physicians dedicated to building healthier communities, the system offers more than 400 sites of care, including eight award-winning medical centers. Specializing in cardiovascular care, cancer care, orthopedics, neuroscience, pediatrics, women's health and rehabilitation medicine. Atlantic Medical Group, comprised of 1,000 physicians and advanced practice providers, represents one of the largest multi-specialty practices in New Jersey and includes finance, legal, marketing, human resources, talent acquisition, ISS and more. Caring for our patients, our team members and the communities we serve is our central mission.
