MED STAFF CREDENTIALING SPECIALIST

Beth Israel Lahey Health•Milton, MA

42d•$26 - $43

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. MED STAFF CREDENTIALING SPECIALIST Job Description: ESSENTIAL RESPONSIBILITIES: Supports all aspects of medical staff credentialing and privileging in accordance with hospital policies, Medical Staff Bylaws, and regulatory standards (e.g., The Joint Commission, CMS, and state and federal requirements). Processes new appointments, reappointments, temporary privileges, category changes, and resignations in a timely and accurate manner. Audits and analyzes credentialing files received from the CVO for accuracy and completeness, including identifying and investigating red flags or adverse information that may require further follow-up. Adheres to established workflows and complies with required credentialing file turnaround times. Assists the CVO, when needed, to follow up with providers regarding late application submissions or missing documentation. Performs timely follow-up on missing or incomplete information to ensure applications are processed efficiently. Prepares credentialing files accurately and in a timely manner for review by hospital leadership and obtains all required approvals. Effectively communicates, both verbally and in writing, with providers, hospital leadership, and staff involved in the credentialing process. Monitors and participates in tracking expiring credentials such as federal and state DEA registrations, state licenses, professional liability insurance, and specialty board certifications, ensuring timely renewals as assigned. Updates and maintains provider electronic credentialing records, ensuring timely, accurate, and complete database entries. Assists with the preparation of materials for Credentials Committee and Medical Executive Committee meetings, including agendas, minutes, meeting materials, and credentialing lists. Prepares and sends appointment and reappointment approval letters following Board of Trustees approval, within 30 days. Prepares application request forms for submission to the CVO, as assigned. Responds promptly and professionally to telephone calls and email inquiries. Maintains current knowledge of relevant regulatory standards (e.g., TJC, NCQA), as well as state and federal requirements and applicable Medical Staff Bylaws. Assists in the development and implementation of credentialing and recredentialing workflows to ensure efficient and effective alignment of processes. Assists in the development and revision of credentialing-related forms. Compiles OPPE/FPPE data for all medical staff providers. Participates in special projects and team initiatives as assigned. Takes a proactive role in monitoring and supporting improvements in team productivity. Continually strives to achieve individual, team, and departmental goals. Provides support as needed for maintaining departmental on-call schedules and assisting with data entry in EPIC and related systems. Supports general administrative functions of the Medical Staff Office, including phone coverage, supply management, and responding to inquiries. Participates in special projects and performance improvement initiatives as assigned. Demonstrates flexibility and initiative in responding to changing departmental needs.

Requirements

High school diploma or GED required; Associate’s or Bachelor’s degree preferred.
Minimum one (1) year of administrative or clerical experience in an acute healthcare setting or medical provider office required.
Strong organizational skills with exceptional attention to detail and accuracy.
Excellent written, verbal, and interpersonal communication skills.
Proficiency in credentialing software, Microsoft Office Suite, and database management.
Ability to respond calmly and effectively to unexpected work demands, prioritize multiple tasks, and meet established deadlines.
Sound judgment and discretion when handling confidential or sensitive information.
Ability to work both independently and collaboratively in a fast-paced environment.
Maintains required competencies (both position-specific and hospital-wide).
Performs all duties in compliance with hospital policies, safety standards, and applicable laws and regulations.
May be required to perform similar or related duties as assigned or in response to departmental needs.

Nice To Haves

CPCS (Certified Provider Credentialing Specialist) preferred.
Two (2) to three (3) years of experience in a Medical Staff Office or Central Verification Office (CVO) with direct credentialing and privileging responsibilities preferred.

Responsibilities

Supports all aspects of medical staff credentialing and privileging in accordance with hospital policies, Medical Staff Bylaws, and regulatory standards (e.g., The Joint Commission, CMS, and state and federal requirements).
Processes new appointments, reappointments, temporary privileges, category changes, and resignations in a timely and accurate manner.
Audits and analyzes credentialing files received from the CVO for accuracy and completeness, including identifying and investigating red flags or adverse information that may require further follow-up.
Adheres to established workflows and complies with required credentialing file turnaround times.
Assists the CVO, when needed, to follow up with providers regarding late application submissions or missing documentation.
Performs timely follow-up on missing or incomplete information to ensure applications are processed efficiently.
Prepares credentialing files accurately and in a timely manner for review by hospital leadership and obtains all required approvals.
Effectively communicates, both verbally and in writing, with providers, hospital leadership, and staff involved in the credentialing process.
Monitors and participates in tracking expiring credentials such as federal and state DEA registrations, state licenses, professional liability insurance, and specialty board certifications, ensuring timely renewals as assigned.
Updates and maintains provider electronic credentialing records, ensuring timely, accurate, and complete database entries.
Assists with the preparation of materials for Credentials Committee and Medical Executive Committee meetings, including agendas, minutes, meeting materials, and credentialing lists.
Prepares and sends appointment and reappointment approval letters following Board of Trustees approval, within 30 days.
Prepares application request forms for submission to the CVO, as assigned.
Responds promptly and professionally to telephone calls and email inquiries.
Maintains current knowledge of relevant regulatory standards (e.g., TJC, NCQA), as well as state and federal requirements and applicable Medical Staff Bylaws.
Assists in the development and implementation of credentialing and recredentialing workflows to ensure efficient and effective alignment of processes.
Assists in the development and revision of credentialing-related forms.
Compiles OPPE/FPPE data for all medical staff providers.
Participates in special projects and team initiatives as assigned.
Takes a proactive role in monitoring and supporting improvements in team productivity.
Continually strives to achieve individual, team, and departmental goals.
Provides support as needed for maintaining departmental on-call schedules and assisting with data entry in EPIC and related systems.
Supports general administrative functions of the Medical Staff Office, including phone coverage, supply management, and responding to inquiries.
Participates in special projects and performance improvement initiatives as assigned.
Demonstrates flexibility and initiative in responding to changing departmental needs.

Benefits

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities.
Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.
Equal Opportunity Employer/Veterans/Disabled
At Beth Israel Lahey Health, we are driving the change in health care that Massachusetts wants and needs.
Our culture promotes continuous learning, growth, innovation and a sense of belonging.
We make it a priority to offer comprehensive compensation and benefits and help you achieve a healthy and balanced life.
While you're busy caring for and supporting our patients, we take care of you.

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