Position Summary
The Hospital Credentialing Specialist supports OrthoLoneStar providers in the medical staff credentialing and privileging process for initial appointments, reappointments, and privilege modifications. This role coordinates collection and validation of practitioner information, performs primary source verification, monitors expirable credentials, and prepares complete files for facility Medical Staff Office leadership, committees, and governing board review. The Specialist partners with physicians and allied health professionals, department leadership, compliance, and quality teams to ensure timely, accurate, and compliant credentialing in accordance with hospital policies, bylaws, and applicable state, federal, payor, and accreditation standards.
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Minimum 3+ years of experience in hospital credentialing/privileging, medical staff services, or provider credentialing required.
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High school diploma or equivalent required; Associate’s degree or higher preferred.
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Credentialing certification (CPCS or CPMSM) preferred or willingness to obtain within a defined timeframe.
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Strong verbal and written communication skills with a provider-first service mindset.
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Excellent organizational skills and attention to detail; able to manage multiple provider onboarding files simultaneously.
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Effective time management with the ability to consistently meet onboarding and credentialing turnaround times.
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Strong interpersonal skills; able to coordinate across HR, Operations, Billing, Compliance, and Medical Staff teams.
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Comfortable operating in a fast-paced environment with shifting priorities and high-volume onboarding schedules.
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Self-directed and accountable; proactively identifies barriers and drives issues to resolution.
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Demonstrated knowledge of hospital credentialing, privileging, and medical staff appointment processes (initial, reappointment, and privilege changes).
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Ability to interpret and apply Medical Staff Bylaws, credentialing policies, delineation of privileges (DOP) forms, and verification standards.
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Ability to maintain confidentiality and manage sensitive provider and employee information with discretion.
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Strong documentation and recordkeeping skills with a focus on audit readiness and data accuracy.
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Proficiency with Microsoft Office (Excel/Word/Outlook) and ability to learn and use hospital credentialing systems (e.g., VerityStream, symplr, MD-Staff) and external verification resources (e.g., NPDB, state licensing boards, specialty boards).
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Commitment to teamwork, continuous improvement, and delivering a consistent, high-quality onboarding experience.
Credentialing & Privileging Coordination / File Management
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Coordinate initial appointment, reappointment, and privilege change processes from application receipt through final approval, partnering with providers and the facility Division leadership and facility Medical Staff Offices to confirm requested privileges and required documentation.
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Collect, review, and maintain credentialing documentation (applications, licensure, DEA/CDS as applicable, board certification, education/training, work history, malpractice coverage and claims history, references, immunizations, trainings, and required attestations).
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Track expirable credentials, send renewal reminders, and maintain accurate practitioner files and privilege forms within credentialing databases and shared repositories.
Primary Source Verification & Compliance
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Perform primary source verification of licensure, education, training, board certification, work history, peer references, and malpractice coverage in accordance with Medical Staff policies.
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Ensure compliance with The Joint Commission and/or DNV standards (as applicable), CMS Conditions of Participation, state and federal regulations, and hospital bylaws and policies.
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Complete required screenings and queries (e.g., NPDB, OIG/SAM, state licensure actions, sanctions) and coordinate follow-up for any findings, discrepancies, or required clarifications.
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Prepare complete credentialing and privileging packets for review by department chairs, Credentials Committee, Medical Executive Committee, and governing board, as applicable.
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Maintain credentialing/privileging timelines; document verification sources and committee actions to support audit readiness, survey preparedness, and data integrity
Committee, Meeting, & Approval Support
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Coordinate and track committee review cycles (e.g., Credentials Committee, MEC) and governing board approval timelines for appointments, reappointments, and privilege changes.
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Communicate approval outcomes, effective dates, and any conditions to relevant stakeholders (practitioners, supervising physician and division leadership) per policy.
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Update credentialing/privileging status in applicable systems and trackers; coordinate with downstream teams (e.g., IT/EHR access, Division leadership) to support practitioner readiness.
Communication & Provider Support
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Serve as a primary point of contact for practitioners regarding application requirements, credentialing/privileging status, missing items, and expected timelines.
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Provide clear instructions, reminders, and document requests to practitioners. to keep credentialing files complete and moving through review efficiently.
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Escalate discrepancies, potential compliance risks, or credentialing barriers to OrthoLoneStar credentialing.
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Provide routine status updates to internal stakeholders (Division leadership, compliance/quality, HR as needed) to ensure coordinated review and approval readiness.
Administrative & System Support
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Enter and maintain practitioner data and documentation in credentialing systems; ensure data consistency across databases and OLS credentialing department files
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Generate and distribute credentialing status reports, reappointment/expirable tracking summaries, and aging reports as requested.
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Maintain trackers, calendars, and dashboards for reappointment cycles, committee schedules, and follow-up items to support timely completion and clear ownership of next steps.
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Support process improvement by identifying recurring file deficiencies, turnaround delays, or survey/audit findings and recommending workflow, policy, or documentation enhancements.
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Monitor and triage the Hospital Medical Staff Office/Credentialing inbox; respond, route requests, and track items to completion.
Other Duties
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Assist with departmental projects.
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Perform diversified clerical and administrative activities as needed.
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Complete other duties as assigned.
Physical & Mental Requirements
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Visual and auditory accuracy required.
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8-hour shift in an indoor setting.
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Continuous use of computers and calculators.
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Prolonged periods of sitting.
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Frequent use of telephone and continuous conversational communication.
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Visual and auditory accuracy required.
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8-hour shift in an indoor setting.
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Continuous use of computers and calculators.
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Prolonged periods of sitting.
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Frequent use of telephone and continuous conversational communication.
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Frequent repetitive grasping and manipulation of both hands.
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Occasional reaching, walking, squatting, bending, kneeling, twisting, or climbing.
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Occasionally carrying, lifting, pushing, or pulling up to 25 lbs.
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Occasional work in confined, noisy, or dusty areas.
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Ability to understand and carry out oral and written instructions.
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Ability to memorize, retain, and apply instructions.
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Ability to read and interpret detailed specifications.
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Understanding of hospital medical staff credentialing and privileging standards and best practices.
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Working knowledge of The Joint Commission and/or DNV standards (as applicable) for medical staff credentialing, privileging, and reappointment.
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CMS Conditions of Participation and other regulatory requirements relevant to medical staff credentialing and privileging.
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Medical Staff Bylaws, Rules & Regulations, credentialing policies/procedures, and committee/governing board approval workflows.
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Understanding of state licensing boards and ongoing monitoring for updates, expirations, restrictions, and disciplinary actions.
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Familiarity with NPDB, OIG/SAM, specialty boards, malpractice carriers, and hospital credentialing systems/tools used to support verification and privileging.
