Medical Staff Credentialing Specialist

The Medical Staff Credentialing Specialist is responsible for managing the full lifecycle of provider credentialing, recredentialing, and facility privileging for hospitals and ASCs. This role ensures compliance with accrediting bodies, state regulations, and internal medical staff governance processes. The Specialist verifies provider qualifications, maintains accurate credentialing data, and coordinates privilege approvals to support timely onboarding and uninterrupted clinical practice. This position requires exceptional attention to detail, strong communication, and the ability to manage a high‑volume caseload in a hybrid environment.

• Coordinate initial and reappointment privileging for physicians, APPs, and allied health professionals across assigned facilities.
• Ensure privilege delineation forms are current, accurate, and properly routed for department chair, Credentials Committee, MEC, and Governing Board review.
• Manage FPPE/OPPE processes including tracking requirements, collecting proctoring documentation, and coordinating performance evaluations.

• Manage the intake, review, and completion of applications for credentialing and recredentialing, meeting established SLA timelines.
• Conduct detailed primary source verification for licensure, training, board certification, NPDB, malpractice history, work history, references, and sanctions.
• Maintain ongoing monitoring including license renewals, DEA, and certification expirations.
• Work closely with payer enrollment team to align privileging approval with health plan participation and go‑live dates.

• Ensure compliance with TJC/DNV/HFAP, CMS Conditions of Participation, state board regulations, and organizational medical staff bylaws.
• Maintain accurate electronic files and provider records within credentialing systems.
• Assist with internal and external audits, including surveys and accreditation reviews.
• Protect confidential information in accordance with HIPAA and organizational security policies, including for remote work environments.

• Serve as the primary point of contact for providers regarding application status, expectations, timelines, and required documentation.
• Partner with Medical Staff leadership, HR, Risk Management, Quality, and Legal on complex credentialing or privileging issues.
• Communicate proactively regarding delays, red flags, or barriers to provider start dates.
• Participate in process improvement initiatives such as workflow optimization, electronic form updates, and automation.

• Experience in healthcare administration, credentialing, medical staff services, compliance, legal admin, project coordination, or related field
• 1-2 years of experience in facility privileging and medical staff credentialing within a hospital, ASC, or credentialing office.
• Ability to manage multiple priorities in a hybrid setting with minimal supervision.
• Strong written and verbal communication skills; high attention to detail.
• Takes initiative and problem solves instead of waiting for direction
• Proficient with Microsoft Office/Excel and general data tracking
• Comfortable learning new systems and processes quickly

• Experience with multi‑facility health systems, ASC privileging, or payer enrollment coordination.
• Familiarity with OPPE/FPPE workflows and audit preparation activities.
• Experience working in a hybrid credentialing environment.
• Working knowledge of regulatory and accreditation requirements (TJC, DNV, CMS).
• Experience using credentialing software (MD‑Staff, Cactus/symplr, Verity Stream, Medallion, One App).

• Regulatory Compliance
• Data Accuracy & Integrity
• Professional Communication
• Workflow & Time Management
• Stakeholder Collaboration
• Process Improvement
• Confidentiality & Security (especially in remote settings)

This role may be performed remotely with:

• Reliable high‑speed internet
• Secure remote workspace compliant with HIPAA standards
• Ability to participate in virtual committee meetings, audits, and team meetings
• Occasional travel to office for in person meetings.

This position offers flexible work options. Occasional on‑site attendance is required for certain meetings or team collaboration sessions.