Responsibilities
- Engages in team initiatives to uphold quality standards in credentialing, privileging, and primary source verification for medical and allied health practitioners.
- Acts as a departmental resource and works with colleagues to enhance practitioner quality and patient safety.
- Evaluates practitioner eligibility for staff membership or participation.
- Reviews applications and supporting documents for completeness and accuracy, notifying applicants of status and requesting additional details when necessary.
- Gathers and assesses data from original sources to confirm compliance with accreditation and regulatory requirements, including education, training, licensure, work history, hospital affiliations, malpractice history, board certification, criminal background, health status, and peer feedback.
- Identifies, examines, and verifies inconsistencies or adverse findings during credentialing to support informed decision-making.
- Processes privilege requests in accordance with defined clinical criteria when applicable.
- Tracks initial and reappointment procedures for medical and allied health staff to ensure timely processing and adherence to regulations, including required verifications.
- Follows up on completed files during departmental or committee review stages until final approval is granted, ensuring compliance.
- Monitors personal performance metrics related to accuracy and efficiency, communicating with supervisors about concerns or training needs.
- Regularly discusses performance metrics and goals with auditors and leadership.
- Coordinates activities with Credentialing Managers and team members.
- Partners with internal departments and stakeholders such as Compliance, Academic Affairs, Health Services, and Legal to meet policy and regulatory expectations.
- Provides direct updates on applicant file status to providers, department representatives, clients, or affiliates, and coordinates collection of missing documentation to meet deadlines.
- Notifies providers and relevant parties about expiring credentials—including licenses, DEA registration, health screenings, PPD tests, infection control compliance, and specialty requirements—and coordinates renewal efforts.
- Serves as a reference point for medical staff bylaws, policies, and procedures.
- Responds to inquiries from external healthcare organizations and addresses daily credentialing and privileging issues with internal and external stakeholders.
- Works with management to evaluate departmental operations, identify improvement opportunities, and implement changes.
- Supports expirable credentialing tasks such as tracking annual health requirements, licenses, DEA registration, malpractice insurance, and board certification status.
- Represents the Medical Staff Services Department in organizational initiatives and committee meetings as needed.
- Participates as a Team Peer Interviewer when required.
- Performs additional duties as assigned by management.
Other
- Fluent English language skills (oral and written) required
- Proficiency in MS Office (e.g. Word, Excel, and PowerPoint), email, internet required
- Background checks are conducted as part of the credentialing process
- Primary source verification of education, licensure, work history, hospital affiliation, malpractice claims, board certification, criminal background, health status, and peer recommendations is required
- Monitoring of expiring credentials such as license, DEA, health reviews, PPD, infection control, and specialty privilege requirements
