OVERVIEW:  

The Medical Staff Credentialing Specialist plays a pivotal role in ensuring that physicians, Certified  Registered Nurse Anesthetists (CRNAs), and nurses working in the hospital meet all necessary qualifications  and credentials to provide high-quality patient care. This position involves managing the credentialing  process for healthcare professionals, maintaining compliance with regulatory requirements, and facilitating  efficient communication between hospital departments, providers, and external organizations.  

ESSENTIAL DUTIES AND RESPONSIBILITIES:  

1. Credentialing Process Management:  
2. Review and process applications for medical staff appointments, reappointments, and  privileges for physicians, CRNAs, and nurses.  
3. Verify the accuracy and completeness of application materials, including licenses,  certifications, education, and work history.  
4. Maintain organized and up-to-date credentialing files for all healthcare professionals.  2. Verification and Background Checks:  
5. Secure references and perform reference checks.  
6. Conduct primary source verification of all professional credentials, licenses, and  certifications for physicians, CRNAs, and nurses.  
7. Perform background checks and assess the professional qualifications and history of  medical staff members.  
8. Compliance and Regulatory Requirements:  
9. Ensure compliance with all relevant regulatory and accrediting bodies (e.g., The Joint  Commission, CMS, state regulations) for physicians, CRNAs, and nurses.  
10. Stay up to date with changes in healthcare regulations and accreditation standards.  4. Communication and Collaboration: 
11. Collaborate with various hospital departments, including HR, Legal, Quality Assurance,  and medical staff, to facilitate the credentialing process for physicians, CRNAs, and  nurses.  
12. Communicate with healthcare professionals, providing updates on the status of their  credentialing applications.  
13. Data Management: 
14. Maintain an accurate and up-to-date database of medical staff credentials, including  expiration dates and necessary renewals for physicians, CRNAs, and nurses.  
15. Generate and distribute reports related to credentialing status and compliance. 

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6. Quality Assurance: 
7. Participate in quality improvement initiatives related to the credentialing process,  identifying areas for improvement, and implementing best practices for physicians,  CRNAs, and nurses.  
8. Record Keeping and Documentation: 
9. Keep detailed records of the credentialing process, maintaining confidentiality and  security of sensitive information for physicians, CRNAs, and nurses.  
10. Other duties as assigned or as become evident. 

SUPERVISORY RESPONSIBILITIES:  

∙ This job has no supervisory responsibilities.  

COMPETENCIES: 

Language Skills 

∙ Ability to read, analyze and interpret common scientific and technical journals, financial reports, and  legal documents. Ability to respond to common inquiries or complaints from customers, regulatory  agencies, or members of the business community. Ability to write speeches and articles for  publication that conform to prescribed style and format. Ability to effectively present information to  top management, public groups, and or boards of directors.  

Math Skills  

∙ Ability to calculate figures and amounts such as discounts, interest, commissions, proportions,  percentages, area, circumference and volume. Ability to apply concepts of basic algebra and  geometry.  

Reasoning Abilities  

∙ Ability to define problems, collect data, establish facts, and draw valid conclusions.  EDUCATION, EXPERIENCE, and TRAINING:  

∙ Bachelor’s degree (B.A.) from a four-year college or university. 

CERTIFICATES, LICENSES, REGISTRATIONS:  

∙ Certification in Medical Staff Services (e.g., Certified Professional Medical Services  Management – CPMSM) is a plus.  

∙ Previous experience in credentialing or medical staff services in a hospital or healthcare setting is  highly desirable.  

∙ Knowledge of healthcare regulations, accreditation standards, and relevant software applications  

COMPUTER SKILLS:  

∙ Microsoft Windows  

∙ Word Processing Software  

∙ Spreadsheet Software  

∙ Internet Software  

∙ Human Resource System  

∙ Database Software  

TRAVEL REQUIREMENTS:  

∙ Less than 10% of the year 

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PHYSICAL DEMANDS – The physical demands described here are representative of those that must be  met by an employee to successfully perform the essential functions of this job. Reasonable accommodations  may be made to enable individuals with disabilities to perform the essential functions. 

∙ The employee must regularly lift and/or move up to 10 pounds and must occasionally lift and/or  move up to 25 pounds.  

∙ While performing the duties of this job, the employee is occasionally required to stand, walk, sit,  stoop, kneel, crouch, or crawl.  

∙ While performing the duties of this job, the employee is frequently required to use hands to  finger, handle or feel, reach with hands and arms, climb or balance.  

VISION REQUIREMENTS:  

∙ There are no special vision requirements. 

WORK ENVIRONMENT – The work environment characteristics described here are representative of  those an employee encounters while performing the essential functions of this job.  ∙ This position works in an environment with moderate noise level. (Examples: business office with  computers and printers, light traffic.)  

Note: Nothing in this job specification restricts management’s right to assign or reassign duties and  responsibilities to this job at any time. Critical features of this job are described under various headings  above. They may be subject to change at any time due to reasonable accommodation or other reasons, with  or without notice. The above statements are strictly intended to describe the general nature and level of the  work being performed. They are not intended to be construed as a complete list of all responsibilities, duties,  and skills required of employees in this position.