Coordinator Credentialing - Medical Staff Services

Thank you for considering a career at Roper St. Francis Healthcare!

Scheduled Weekly Hours:

40

Work Shift:

Days (United States of America)

Primary Function/General Purpose of Position

Credentialing and Privileging

The Medical Staff Credentialing Coordinator completes credentialing and privileging for physicians and allied health professionals, ensuring compliance with CMS, The Joint Commission, and South Carolina regulations. Responsibilities include processing applications, completing Primary Source Verification, and coordinating with Medical Staff Leadership and the Credentials Committee to support timely provider appointment and reappointment. The role follows established workflows and bylaws while maintaining accuracy, communication, and strong customer service, and partners with Managed Care to ensure compliance with the RSFH Credentialing Plan.

Essential Job Functions

Responsible for Full Cycle Credentialing, Privileging, and (if applicable) Enrollment Processes

• Processes and manages all medical staff and allied health credentialing applications for RSFH, including sending and tracking electronic applications and completing primary source verification of education, training, licensure, DEA, malpractice coverage, affiliations, references, and background checks. Ensures accuracy and compliance with accreditation and regulatory standards including The Joint Commission (TJC), National Committee for Quality Assurance (NCQA) (if applicable), Centers for Medicare & Medicaid Services (CMS) and SC laws.
• Conducts and maintains all credentialing and privileging activities, including determining initial eligibility, identifying and resolving discrepancies, verifying expirable, and preparing practitioner-specific data for review by decision-making bodies. Manages initial and reappointment processes, privilege requests, and application status communication.
• If applicable, handles payer enrollment for employed and contracted providers, processes electronic enrollment applications, updates provider data in the credentialing database, and communicates status updates to internal stakeholders. Requests additional documentation as needed.
• Ensure files and documents are complete and ready for review by the IPN Leader/Credentialing Reviewer, Credential Committees, and Medical Staff Leaders. Collaborates with credentialing auditors to correct deficiencies and completes workflows with accuracy.
• Organizes and maintains provider data and files, ensuring timely processing of applications and meeting quality benchmarks for turnaround times, accuracy, and regulatory metrics. Ensure the provider database is updated with accurate information.
• Follows all regulatory requirements related to primary source verification for medical staff and managed care compliance (if applicable).
• Completes credentialing compliance checkpoints to ensure files are ready for review.
• Maintains awareness of The Joint Commission (TJC), National Committee for Quality Assurance (NCQA) (if applicable), Centers for Medicare & Medicaid Services (CMS), and other regulatory guidelines through continuing education.
• Demonstrates excellent professional communication skills when interacting with colleagues, providers, leadership, and others to collect missing information or resolve issues.
• Responsible for distributing Board correspondence and notifying hospital departments of new medical staff members.
• Attends Credentials Committee, CMEC, and other meetings as required.
• Provides administrative support to the Manager, Medical Staff Services.
• Maintains strict privacy and confidentiality at all times.

Clinical Competency Evaluations

If requested, participates in FPPE, OPPE, and FPPE for cause and conducts and maintains evaluations by preparing structured reports for the IPN/Credentials Reviewer, and investigating discrepancies or adverse findings. Coordinates physician leader review of competency data to support informed evaluation and decision-making.

Credentialing Databases/IT Applications:

Responsible for maintaining current and precise database management and to assure the accuracy of all pertinent information as needed to provide reports, department mailing lists/labels, rosters and to guarantee that all practitioner’s privileges/scope of practice/agreements are renewed according to TJC and federal/state regulatory agency requirements and that there are no lapses in licensure and/or insurance coverage and Board certification. Collects current information on a regular basis from all members of the Professional Medical Staff. May be requested to processes KEPRO acknowledgements, 340 B forms, provider rosters, and other RSFH initiatives.

Meeting Coordination & Minutes Coordinates agendas, gathers materials, prepares electronic packets, issues meeting notices, and transcribes and revises minutes as needed. Tracks follow-up items, maintains department minutes and attendance records, and supports Chairs/designees with meeting preparation as needed.

Performance Improvement & Compliance Assists continuous quality improvement by recommending updates to department policies and procedures, assisting with TJC accreditation preparation, monitoring compliance with standards, and reporting issues to the Manager of Medical Staff Services.

Department Knowledge & Development Maintains current knowledge of Medical Staff Bylaws, Rules, and Regulations, and participates in staff meetings and professional development activities as assigned.

Communication & Professionalism Facilitates communication between Medical Staff Services and other departments by managing calls, relaying updates, and notifying essential departments of provider changes or medical staff issues.

Additional Duties Performs other responsibilities as assigned to support departmental operations and organizational needs.

Licensing/Certification NAMSS certification (CPCS or CPMSM) is preferred at hire and required within five years if not already obtained. Long-term RSFH Medical Staff Services employees (5+ years) are encouraged but not required to be certified. Membership in national, state, or local Medical Staff Services organizations is preferred.

High School Education or GED required; bachelor’s degree preferred.

Work Experience A minimum of two years of credentialing experience in a Medical Staff Office, Centralized Credentialing Organization, or managed care environment required.

Training

Credentialstream Credentialing software (preferred)

Language

None

Patient Population

Not applicable to this position

Working Conditions

Periods of high stress and fluctuating workloads may occur.

May have periods of constant interruptions.

Prolonged periods of working alone.

Physical Requirements - Mark selections with an "X":

Physical Demands

Frequency 0% 1-33% 34-66% 67-100%

Lifting/ Carrying (0-50 lbs.) x

Lifting/ Carrying (50-100 lbs.) x

Push/ Pull (0-50 lbs.) x

Push/ Pull (50-100 lbs.) x

Stoop, Kneel x

Crawling x

Climbing x

Balance x

Bending x

Work Position

Frequency 0% 1-33% 34-66% 67-100%

Sitting x

Walking x

Standing x

Additional Physical Requirements/Hazards

Physical Requirements

Hear alarms/telephone/audio recordings

Repetitive arm/hand movements

Finger Dexterity

Color Vision

Acuity – far

Acuity – near

Hazards

Not applicable to this position

Skills

Medical Staff Credentialing

Data Collection

Data Entry

Healthcare Policies

Confidentiality

Flexibility

Managing Multiple Priorities

Attention to Detail

Critical Thinking

Accuracy

Teamwork

Conflict Resolution

Active Listening

Communication professionally with team, providers and other departments

Relationship building

Writing

Self-motivated

Accountability

Proof reading

Autonomy

Managing deadlines

Roper St. Francis Healthcare is an equal opportunity employer. 

As a Roper St. Francis Healthcare teammate, you’re part of a Misson that matters. We support your well-being – personally and professionally. Our benefits are built to grow with you and meet your unique needs, every step of the way.

What we offer

• Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)

• Medical, dental, vision, prescription coverage, HAS/FSA options, life insurance, mental health resources and discounts

• Paid time off, parental and FMLA leave, and short- and long-term disability

• Tuition assistance, professional development and continuing education support

Benefits may vary based on the market and employment status.

Department:

Medical Staff Services - Roper St Francis Healthcare

It is our policy to abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a). Accordingly, all applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at [email protected].