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Misinformation has developed into a critical societal threat that can lead to disastrous societal consequences. Although fact-checking plays a key role in combating misinformation, relatively little research has empirically investigated work practices of professional fact-checkers. To address this gap, we conducted semi-structured interviews with 21 fact-checkers from 19 countries. The participants reported being inundated with information that needs filtering and prioritizing prior to fact-checking. The interviews surfaced a pipeline of practices fragmented across disparate tools that lack integration. Importantly, fact-checkers lack effective mechanisms for disseminating the outcomes of their efforts which prevents their work from fully achieving its potential impact. We found that the largely manual and labor intensive nature of current fact-checking practices is a barrier to scale. We apply these findings to propose a number of suggestions that can improve the effectiveness, efficiency, scale, and reach of fact-checking work and its outcomes.