Medical Staff Credentialing Specialist II - Full-Time - Atlantic Health Newton Medical Center

Position Summary:
Determines practitioner eligibility for Medical Staff and Allied Health Professional Staff membership and /or clinical privileges.  Performs complex credentialing, privileging and primary source verification functions requiring advanced analytical skills, critical thinking, and independent judgment. Ensures the integrity, accuracy, and timeliness of credentialing information in compliance with regulatory and accreditation standards. Serves as a key resource to leadership, providers, and interdisciplinary stakeholders to support high-quality practitioner evaluation and patient safety.

Key Responsibilities:

Credentialing & Privileging Oversight:

• Conducts comprehensive initial and recredentialing primary source verification of education, clinical training, licensure, work history, hospital/healthcare affiliations, malpractice claims history, peer references, and other elements as required per the bylaws and policies to ensure competency.

• Identifies, investigates, and resolves discrepancies or adverse findings to support informed decision-making by medical staff leadership and committees.

• Processes clinical privilege requests in alignment with established clinical/specialty criteria.

Regulatory Compliance & File Management:

• Manages credentialing workflows to ensure compliance with Joint Commission, CMS, and NCQA standards, maintaining strict adherence to required timelines.

• Monitors file progression through review and approval stages, ensuring completeness, accuracy, and audit readiness.

Stakeholder Engagement & Communication:

• Serves as a liaison to physicians, advanced practice providers, and internal/external stakeholders to communicate application status, resolve issues, and obtain required documentation.

• Provides guidance on medical staff bylaws, policies, and credentialing requirements, and responds to verification inquiries and organizational requests.

Performance & Continuous Improvement:

• Independently manages productivity and quality metrics, ensuring high standards of accuracy and efficiency.

• Contributes to process improvement initiatives, supports system optimization efforts, and participates in departmental and organizational projects.

Education/Experience

• High School Diploma required. Bachelor's Degree Preferred.
• 3 years of credentialing experience in a hospital or healthcare setting.
• Strong knowledge of Joint Commission, CMS, and NCQA standards.
• Demonstrated ability to analyze complex information, exercise sound judgment, and manage competing priorities.
• CPCS or CPMSM preferred