Guthrie
Central Credential/Verification Coordinator - Legal - Full Time (Sayre)
Guthrie, Sayre, Pennsylvania, United States, 18840
Summary:
The Medical Staff Professional (MSP) ensures compliance with accreditation standards, regulatory requirements, and organizational policies by managing and coordinating practitioner credentialing, privileging, and medical staff governance support. This position supports quality patient care by conducting thorough credentialing activities in accordance with NAMSS Ideal Credentialing Standards (ICS), facilitating communication between departments, and serving as a central liaison for medical staff operations. This is a hybrid position, with a combination of remote work and on-site presence as required by operational needs.
Experience:
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Minimum of 3 years of experience in a medical staff or credentialing role.
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Knowledge of NAMSS ICS, Joint Commission, NCQA, CMS, and state credentialing requirements (New York and Pennsylvania preferred).
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Proficiency in Microsoft Office 365 and credentialing systems
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Excellent verbal and written communication, organizational, and interpersonal skills.
Education: Required: High School Grad or Equivalent Preferred: Two Year Degree Non Nursing Licenses: NAMSS Certification (CPCS) preferred or required within 3 years of hire. Essential Functions: Credentialing & Privileging -
Conducts initial and reappointment credentialing and privileging processes for licensed independent practitioners (LIPs) and advanced practice professionals (APPs).
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Performs and documents primary source verification (PSV) of the 13 essential ICS elements, including but not limited to education, licensure, DEA, malpractice, and references.
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Recognizes, investigates, and resolves discrepancies and red flags in applications or verifications.
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Ensures accurate processing of privilege requests in collaboration with physician leaders.
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Maintains credentialing files in compliance with Joint Commission, NCQA, CMS, state, and organizational standards.
Clinical Competency & Quality Support -
Assists in preparing OPPE/FPPE documentation, peer reviews, and quality audits for credentialed providers.
Medical Staff Governance -
Ensures appropriate documentation is reviewed and submitted for credentialing recommendations and approvals.
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Maintains compliance with bylaws, rules & regulations, and ensures updates are reflected in credentialing policies.
Data & Systems Management Manages the credentialing database and ensures timely updates of all expirable (licenses, certifications, insurance). Including preparation of reports, audit logs, and rosters for internal and external stakeholders. Regulatory Compliance -
Assists in maintaining readiness for audits and accreditation surveys.
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Participates in delegated credentialing audits and prepares necessary documentation.
Other Duties: Required: Other duties as assigned
Minimum of 3 years of experience in a medical staff or credentialing role.
-
Knowledge of NAMSS ICS, Joint Commission, NCQA, CMS, and state credentialing requirements (New York and Pennsylvania preferred).
-
Proficiency in Microsoft Office 365 and credentialing systems
-
Excellent verbal and written communication, organizational, and interpersonal skills.
Education: Required: High School Grad or Equivalent Preferred: Two Year Degree Non Nursing Licenses: NAMSS Certification (CPCS) preferred or required within 3 years of hire. Essential Functions: Credentialing & Privileging -
Conducts initial and reappointment credentialing and privileging processes for licensed independent practitioners (LIPs) and advanced practice professionals (APPs).
-
Performs and documents primary source verification (PSV) of the 13 essential ICS elements, including but not limited to education, licensure, DEA, malpractice, and references.
-
Recognizes, investigates, and resolves discrepancies and red flags in applications or verifications.
-
Ensures accurate processing of privilege requests in collaboration with physician leaders.
-
Maintains credentialing files in compliance with Joint Commission, NCQA, CMS, state, and organizational standards.
Clinical Competency & Quality Support -
Assists in preparing OPPE/FPPE documentation, peer reviews, and quality audits for credentialed providers.
Medical Staff Governance -
Ensures appropriate documentation is reviewed and submitted for credentialing recommendations and approvals.
-
Maintains compliance with bylaws, rules & regulations, and ensures updates are reflected in credentialing policies.
Data & Systems Management Manages the credentialing database and ensures timely updates of all expirable (licenses, certifications, insurance). Including preparation of reports, audit logs, and rosters for internal and external stakeholders. Regulatory Compliance -
Assists in maintaining readiness for audits and accreditation surveys.
-
Participates in delegated credentialing audits and prepares necessary documentation.
Other Duties: Required: Other duties as assigned