In this role, you will be responsible for reviewing and assessing credentialing applications to ensure compliance with legal, regulatory, and internal policy requirements. You will utilize established guidelines, tools, and the Credentialing Manual to make informed pass/fail decisions while providing clear, professional communication to applicants and internal stakeholders. The role involves daily interaction with customers, meticulous documentation, and ongoing training to stay current with policy updates. Success in this position requires excellent communication skills, strong customer focus, and the ability to navigate a production-based environment with accuracy and urgency. Manage a working queue to meet productivity, accuracy, and SLA targets. Perform credentialing reviews based on the specific request type and apply complex, documented policies and procedures accurately. Respond to inquiries from internal departments and external customers regarding application status. Communicate with applicants and customers via phone and email to gather required documentation and provide final credentialing decisions. Use multiple systems, tools, and verification products to confirm credentialing standards are met. Make accurate final “pass” or “fail” decisions based on regulatory and policy requirements. Document all findings, actions, and communications in the credentialing system (MBS‑ECT) for FTC, vendor/provider, audit, and data retention purposes. Maintain high-quality communication using clear, concise, and customer‑appropriate language. Attend quarterly policy and procedure training sessions, as well as annual refresher training, applying frequent updates (40–45 per year) to daily work. Ensure all credentialing decisions adhere to legal and regulatory requirements and reflect the approved interpretations outlined in the Credentialing Manual.