Medical Staff Office

Meet the Medical Staff Office

Department Email: [email protected]

Michelle Ward
Chief of Quality Improvement
[email protected]
P. (618) 391-6104

Robin Zobrist. MHA, CPMSM, CPCS
Medical Staff Office Manager
[email protected]
P. (618) 391-6140

Brittany Mersinger, RHIT
Credentialing Specialist
[email protected]
P. (618) 391-6142

Debbie Missey, CPCS
Credentialing Specialist
[email protected]
P. (618) 391-6141

Mission

The Anderson Hospital Medical Staff Office is here to assist in simplifying the healthcare practitioner’s experience related to application and primary source verifications. Healthcare practitioners are able to access credentialing documents by either clicking on the below links or by contacting the Medical Staff Office by email at  [email protected].

Services

• Initiate application process by providing credentialing application packet and hospital criteria to applying practitioners.
• Collect and process applications for initial appointment and reappointment.
• Process status change requests and additional privilege requests.
• Obtain primary source verifications (verifying all elements of application directly with the sources; such as medical school, training programs, hospital affiliations, licensures, peer references, etc.
• Maintain credentialing database.
• Assist in preparation and participate in the credentialing verification portion of accreditation and regulatory surveys.
• Coordinates, organizes and attends meetings of the Medical Staff.
• Prepare and distribute call schedules.

Credentialing Forms:

All Initial Credentialing Documents and Miscellaneous Forms should be filled out and emailed to [email protected].

Initial Credentialing Documents:

1. Welcome Letter and Checklist
   
2. State of Illinois Healthcare Professional Credentialing and Business Data Gathering Form
3. Application Fee Invoice
4. Supplemental Information Form
5. Medical Staff Status Description
6. Attestation
7. Consent and Release Form
8. Health Statement
9. Background Check Authorization Form
10. Provider Contact Form
11. Provider Signature Card
12. Conflict Disclosure Statement
13. Statement of Authorization & Release
14. Notice to Physicians Acknowledgement
15. Autofaxing Enrollment
16. CME Form
17. 3-Peer Reference Forms
18. Code of Conduct

Miscellaneous Forms

1. Provider Contact Form
2. Change in Status Request form
3. Additional Privilege Request Form
4. Autofaxing Enrolling Form
5. Resignation Form

Call Schedules:

Call schedules may submit by emailing the Medical Staff Office at [email protected].

Request for Clinical Activity:

Requests for clinical activity may be submitted to [email protected]. Activity logs will cover the past 24-months unless otherwise requested.

Library Requests:

While we don’t have the capability to conduct research, our staff is happy to assist you in requests for specific articles. Requests for articles may be submitted to [email protected]. When applicable, requests should include:

• Journal Name
• Article Name
• Dates
• Issue Number
• Volume
• Page Number(s)