Credentialing & Privileging Subject Matter Expert (SME) – Remote

Our client is an international integrated solutions company supporting a healthier world, safer environments, and stronger global communities. They provide international development, healthcare, and Federal agencies with the knowledge, systems, and teams to advance their missions.

Job Summary:

The purpose of this position is to plan and carry out credentials/privileging requirements by identifying, analyzing, and making conclusive reports of findings aimed at resolving problems and developing detailed procedures and guidelines to supplement established higher command requirements at the intermediate headquarter (HQ) level.

  • Manages, analyzes, evaluates, designs/coordinates, and continually improves the health care providers Credentials Review and Privileging Program. Is the primary interface with hospital credential staff and HQ department and division heads, professional staff, and provides a consultative interface.
  • Receives and assesses providers credentialing packages and conducts research on the medical education and training of providers requesting clinic privileges, Analyzes material for appropriateness, continuity, and authenticity.

Reviews contractor’ verifications to determine the adequacy of investigation outcomes, as well as company compliance to the credentials review portion of the contract. Rejects and returns unsatisfactory submissions and determines if any resulting delay warrants the interruption of workflm·1 to perform the missing verifications locally.

•Tracks, monitors, and registers all physicians (military/civilian) for Federal Drug Enforcement Agency Number for multiple hospitals.

•Develops and executes system and personal trend monitoring mechanisms to identify, track and resolve credential issues that directly impact credentials, files, and the provision of quality patient care.

•Ensures backup manual tracking systems are in place for all providers in matters relative to the Credentials Review and Privileging Program in the event computer system fails.

•Maintains a tracking system for the internal processing of documents relating to credentials
review, staff appointment, and clinical privileges status.

  • Initiates performance appraisal reports for healthcare providers in conjunction with the Performance Improvement Program and the clinical staff reappointment process. When a healthcare provider either transfers to another command, retires, or is released from active duty, ensures the proper disposition of the individual files are accomplished according to HQ guidance.
  • Identifies leadership areas of concern, prepares monthly Credentials agenda and Credentials and Privileging Activities Reports, and distributes monthly Credential Provider report prior to meeting which prepared for review, signature, and endorsement.
  • Provides technical expertise and procedure guidance on the Credentials Review and Adverse Privileging Program Fair Hearing Process, conducting all research and preparatory functions in support of the process. Completes all communication requirements inherent in the Fair Hearing process.
  • Displays expertise in the operation and use of the clinics database such as Centralized Credentials Quality Assurance System (CCQAS).
  • Analyzes and assures verification in accordance with guidance/standards
    established by higher authority, all information relative to the medical
    education and specialized training of clinicians, nurses, and allied health
    specialist at the clinic. Uses this information to establish provider’s bona fine medical expertise prior to their employment at the facility.
  • Coordinates this verification process with various agencies, organizations, and institutions worldwide both in the Federal and civilian sector.
  • Studies current systems and directives to design/revise the process of establishing maintaining and disposing of individual credentials files and individual professional files according to current requirements.•Uses medical background and analytic ability to determine the pertinence of requirements that pertain to specific provider categories. Researches, analyzes, collates, and prepares a variety of monthly and quarterly reports required by higher authority.
  • Ensures completion of local performance appraisal reports for placement in Individual Credentials File and Individual Professional File as required by higher authority.

Required Qualifications:

  • BSc/Associate degree; Degree must be obtained through an accredited institution
  • Credentialing certifications through AHIMA/NAMSS preferred (CPCS, CCS, CPMSM)
  • 5+ years of experience in healthcare organizations to include credentialing and privileging
  • Knowledge of military healthcare business rules, operations, and needs
  • Ability to analyze workflow, healthcare data, and business processes in organizations
  • Ability to evaluate programs for risk, price, operations, and related impacts
  • Current (3+ years) knowledge of healthcare high reliability organization principles and transformation
  • Expert written and verbal communicator

Preferred Qualifications:

  • Familiarity with MHS Healthcare Information Systems and Technology
  • Current (1–3 years) knowledge and experience of current MHS Governance construct and procedures


  • Washington DC area (Remote / Hybrid schedule) Must be able to attend meetings at client site when needed

Please email us at info@esghire.com with resume to be considered for this position.