Credentialing Specialist

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

Job Type:

Regular

Scheduled Hours:

40

Work Shift:

Day (United States of America)

The CVO Credentialing Specialist shall be accountable for performing all the duties related to the sending, receiving, processing, and primary source verifying applications for initial and reappointment and their related clinical privileges.
Exemplifies a culture of excellence, effective communication and collaboration, and customer service with CVO leadership and staff, internal and external customers, providers, and clinical and administrative leaders within BILH.
Handles, with discretion, issues that are significant, complex, multidisciplinary, sensitive, and confidential.
Possesses and/or develops a strong grasp of the medical staff operations and the cultures of each affiliated institution and works to find common ground.
Works to develop an overall singular culture of excellence and efficiency system wide.

Job Description:

Essential Duties & Responsibilities including but not limited to:

In accordance with established CVO policies and procedures for assigned hospitals, the CVO Credentialing Specialist shall include the following:

• Application management and verification activities, preliminary analysis of application and verification information, and analyzing verification information, to include identifying red flag and/or adverse information and notifying CVO leadership in accordance with CVO policies.

• Monitoring of expiring information such as, but not limited to, federal and state DEA, state professional license(s), professional liability insurance, and specialty board certification status.

• Maintain and update credentials file(s) (paper and/or electronic as applicable), timely, accurate, and complete database entries, and maintenance of electronic files, as required.

• Appropriately and timely communicate with assigned medical staff offices.

• Timely and accurately prepare credential files for audit and submission to assigned hospitals.

• Compliance with standard turn-a-round times.

• Maintain a working knowledge of relevant regulatory standards (i.e., TJC and NCQA), state and federal requirements, and applicable Medical Staff Bylaws.

• Assist with the development and implementation of credentialing and recredentialing workflows to ensure efficient and effective alignment of processes and assists in the development or revision of credentialing related forms.

• Participation in special project teams as assigned.

• Takes a proactive role in monitoring and assisting in improving team productivity and continually strives to achieve individual, team and departmental goals.

Minimum Qualifications:

Education:

• High School Diploma.

Licensure, Certification & Registration:

• Certified Professional in Medical Staff Management (CPMSM)

OR

• Certified Provider Credentialing Specialist (CPCS) preferred

OR

• Achievement of certification (CPMSM/CPCS) within 24 months of becoming eligible.

Experience:

• At least two (2) years of experience in a CVO or Medical Staff Services in an acute healthcare setting, including credentialing and privileging is preferred.

Skills, Knowledge & Abilities:

• 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.

FLSA Status:

Non-Exempt

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) and COVID-19 as a condition of employment. Learn more about this requirement.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled