CREDENTIALING COORDINATOR, MEDICAL STAFF SERVICES

At SGMC Health, we are collectively working towards goals that will make our community a better place. We strive for excellence by doing the right thing the right way, holding ourselves accountable, and delivering compassionate service. Team spirit is encouraged through collaboration, support for personal and professional growth, and innovation. Our award-winning performance reflects our commitment to providing exceptional care.

Benefits

• Low healthcare insurance premiums
• 401(k) with employer match
• Paid Time Off (PTO)
• Employee discounts
• Company-paid life insurance
• Short-Term and Long-Term Disability
• Cancer Insurance
• Accident Insurance
• Pet Insurance
• Tuition Reimbursement
• On-the-job training and skills development
• Opportunities for growth and advancement
• Employee Assistance Program

About the Role

This full-time, day-shift position in Medical Staff Services involves planning, organizing, and maintaining centralized, comprehensive credentialing for the Medical Staff. Responsibilities include managing pre-applications, initial appointments, annual reviews, reappointments, proctoring, and privileging in accordance with regulatory, accrediting agency, and bylaws requirements.

Responsibilities

• Conduct background checks, DEA checks, license checks, and reference checks to ensure validity and currency.
• Determine if candidates meet qualifications based on background checks, education, licensing, health requirements, and national data bank results.
• Investigate and validate discrepancies and adverse information from applications or primary source verifications.
• Present findings and recommendations, including those adverse to the applicant, to the Director of Medical Staff Services.
• Collaborate with the CMO, Chief of Staff, Department Chairmen, Section Chiefs, PQC, AHP/LLP, and Medical Staff Director in the review and recommendation process.
• Ensure Medical Staff By-Laws, Threshold Criteria, Rules, Regulations, and Joint Commission standards are current and compliant.
• Audit, assess, procure, implement, and maintain practitioner/provider credentialing processes and information systems.
• Collaborate with hospital entities, schools, and other organizations for affiliations and employment verifications.
• Respond to queries regarding physician credentials from external and internal organizations.
• Obtain signatures from departmental section chiefs upon completion of the credentialing process.
• Coordinate provider relinquishments with system administrators.
• Verify supervising physicians for all Allied Health Professionals with the Composite Medical Board.
• Assist the quality department with focused and ongoing professional peer evaluation (FPPE, OPPE).
• Perform delegated credentialing for providers outside the hospital, such as Urgent Care/Youth Care.
• Visit physicians’ offices to obtain signatures when necessary.
• Assist the Chief Medical Officer, Compliance Department, and Medical Staff Director with reports, special projects, and correspondence.

Requirements

• Undergraduate degree from a regionally accredited institution in business or a healthcare-related field, and three to five years of experience in Medical Staff Services, or a combination of education and experience.
• Ability to review, research, and make sound decisions based on findings during the credentialing process.
• Professional communication skills to present findings, discrepancies, or concerns regarding credentialing.
• Knowledge of medical terminology preferred.
• Proficient computer skills, including Microsoft Word, Excel, and Outlook.
• CPMSM or CPCS Certification obtained after three years in the role of Credentialing Coordinator.
• Ability to work independently, prioritize projects, and maintain impeccable integrity and ethics.
• Excellent critical thinking, organizational, and communication skills (both oral and written).
• Attention to detail and accuracy in all tasks.
• Ability to research bylaws and legal guidelines.
• Competency in de-escalating grievances and handling stressful situations with sound judgment.
• Proficiency in using PCs and required tools.

Working Conditions

This role is primarily office-based with a safe working environment. There may be occasional irregular work hours, noise, and crowded conditions. The position involves sitting, standing, and bending, with moderate stress at times.