CVO Credentialing Coordinator

Beth Israel Lahey Health•Woburn, MA

3d•$29 - $38

About The Position

When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. The CVO Credentialing Specialist is accountable for the independent management, analysis, and primary source verification of credentialing applications for initial appointment and reappointment, including associated clinical privileges, in accordance with BILH CVO policies, regulatory standards, and accreditation requirements. This role requires the exercise of professional judgment in evaluating credentialing data, identifying potential compliance risks, and ensuring the accuracy, completeness, and audit-readiness of credentialing files. The Credentialing Specialist supports timely provider onboarding and ongoing compliance by maintaining high standards of data integrity, documentation, and communication. The CVO Credentialing Specialist exemplifies a culture of excellence, effective communication, collaboration, and customer service while working with CVO leadership and staff, providers, Medical Staff Offices, and clinical and administrative leaders across the BILH system. The position routinely handles information that is complex, sensitive, multidisciplinary, and confidential, and requires a strong working knowledge of medical staff operations, regulatory requirements, and the unique cultures of affiliated institutions. The role contributes to the advancement of a standardized, efficient, and compliant system-wide credentialing operation.

Requirements

High School Diploma or higher
At least two (2) years of experience in a centralized credentialing and verification office (CVO) or Medical Staff Services in an acute healthcare setting, including experience in processing initial and/or reappointment applications is preferred.
Knowledge of credentialing software and associated applications strongly preferred.
Excellent interpersonal and communication skills
Ability to work under minimal supervision and to adapt quickly to changes within the environment.

Nice To Haves

CPCP or CPMSM Certified is preferred OR Willingness to achieve CPCS certification.

Responsibilities

Independently manages credentialing applications for initial appointment and reappointment, including application intake, validation, verification, and ongoing status management.
Conducts primary source verification activities and performs detailed analysis of application and verification data to ensure accuracy, completeness, and compliance with regulatory, accreditation, and organizational requirements.
Evaluates verification results to identify red flag, adverse, or inconsistent information and escalates findings to CVO leadership in accordance with established policies, exercising professional judgment to support appropriate review and resolution.
Monitors and tracks time-sensitive credentialing elements, including but not limited to state licensure, DEA registration, professional liability insurance, and specialty board certification, to ensure continuous compliance.
Maintains complete, accurate, and audit-ready credentialing files in paper and/or electronic format, ensuring documentation meets internal standards and external audit requirements.
Ensures the integrity, accuracy, and timeliness of credentialing data entered into credentialing databases and associated systems.
Prepares credentialing files for internal review, peer audit, committee consideration, and submission to assigned hospitals, ensuring adherence to established turnaround times and quality standards.
Participates in peer-to-peer credential file audits and quality review activities as assigned, contributing to continuous process improvement and consistency across the CVO.
Communicates effectively with supervisors and team leads regarding application status, barriers, and resolution needs to support workflow efficiency and service level expectations.
Maintains a working knowledge of applicable accreditation, regulatory, and statutory requirements (including but not limited to TJC and NCQA standards) and applies this knowledge to daily credentialing activities.
Participates in special projects, workgroups, and system-wide initiatives as assigned, supporting standardization, efficiency, and quality improvement within the CVO.