Medical Staff Credentialing Specialist II - Atlantic Health Chilton Medical Center

30% Credentialing and Privileging

• Conducts comprehensive initial and recredentialing primary source verification of education, clinical training, licensure, work history, hospital/healthcare affiliations, malpractice claims history, peer references, and other elements as required per the bylaws and policies to ensure competency.
• Identifies, investigates, and resolves discrepancies or adverse findings related to the practitioners to support informed decision-making by medical staff leadership and committees. This includes thorough review and follow-up on a broad range of adverse or potentially concerning information, such as prior or current disciplinary actions (e.g., suspended, restricted, or revoked privileges), terminations or resignations in lieu of termination from employment or medical staff membership, documented professional misconduct or behavioral concerns, malpractice claims history and patterns, licensure actions or sanctions, and criminal history.
• Conducts detailed analysis of findings to distinguish isolated or non-substantive issues from patterns that may indicate risk, ensuring appropriate context is obtained through primary source verification, reference feedback, and collaboration with internal and external stakeholders. Escalates significant or unresolved concerns in accordance with established policies and supports the development of clear, objective summaries for review by clinical leadership, Credentials Committees, and the Medical Executive Committee.
• Ensures all investigations are handled consistently, confidentially, and in compliance with regulatory and accreditation standards, supporting defensible and well-informed privileging and appointment decisions.
• Processes clinical privileging requests in alignment with established clinical criteria. Reviews and evaluates each request to ensure the privileges sought are appropriate based on the practitioner’s documented clinical training, experience, and current competence. Verifies that all eligibility requirements for both core and special privileges are met, including confirmation of specialized training, certifications, case volume, and demonstrated competency where applicable.
• Ensures all supporting documentation is complete and obtained through primary sources and escalates any discrepancies or concerns to clinical leadership for further review.
• Supports the development of accurate, defensible privilege recommendations for consideration by Medical Staff leadership and governing committees.

25% Regulatory Compliance & File Management:
• Electronically routes credentialing files to Department Chiefs/Chairs or designees for review and recommendations regarding Medical Staff membership and clinical privileges across assigned hospitals upon completion of the file audit.
• Manages credentialing workflows to ensure compliance with Joint Commission, CMS, and NCQA standards, maintaining strict adherence to required timelines. Tracks applications from intake through final Board action, ensuring all verifications, documentation, and privilege evaluations are complete, accurate, and audit-ready, while proactively addressing delays and escalating issues as needed.
• Coordinates and monitors practitioner files through all review and approval stages, including Credentials Committee, Medical Executive Committee, and Governing Board. Ensures accurate documentation of committee actions and supports the development of clear, defensible recommendations for leadership review.
• Executes timely post-approval actions to operationalize practitioner status. Updates the credentialing system to reflect approved membership and privileges, prepares and distributes Board approval communications to practitioners and applicable leadership, and coordinates with IT and operational teams to ensure EMR access and full activation for clinical practice.

25% Administrative and Operational Support
• Provides support to practitioners throughout the credentialing and privileging process, guiding them through complex requirements and ensuring a positive onboarding experience.
• Serves as a primary point of contact, clearly explaining requirements, assisting with document collection, and helping navigate potentially burdensome or time-intensive steps.
• Proactively communicates status updates, outstanding items, and anticipated timelines, keeping applicants informed and engaged throughout the process.
• Anticipates and addresses questions or barriers early to prevent delays, ensuring a transparent, efficient, and provider-centered experience from application through final approval.
• Collaborates with clinical departments, HR, legal, and external entities (e.g., licensing boards, malpractice carriers) to facilitate timely information exchange and resolve issues that may impact credentialing decisions.
• Coordinates day-to-day activities of the Medical Staff Office, including managing communications, scheduling, document preparation, and responding to routine inquiries from providers and internal stakeholders.

20% Performance & Continuous Improvement:
• Independently manages productivity and quality metrics, ensuring high standards of accuracy and efficiency.
• Monitors workflows and outcomes to identify trends, gaps, and opportunities for process improvement, contributing to ongoing optimization efforts.
• Supports standardization and continuous improvement initiatives to enhance efficiency, strengthen compliance, and advance a high-quality, provider-centered credentialing program.

• High School Diploma Required. Associate's or Bachelor's degree in Business, Finance, Healthcare, or related field preferred.
• Minimum 3 years of credentialing experience in a hospital or integrated healthcare system.
• Experience with Credentialing Software Data Base Systems (e.g., Verity Credential Stream, Echo, MDStaff)
• Demonstrated ability to analyze complex information, exercise sound judgment, and manage competing priorities.
• Strong knowledge of Joint Commission, CMS, and NCQA standards.
• Excellent communication and training skills with the ability to provide constructive feedback.
• CPCS or CPMSM strongly preferred