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Credentialing Specialist


Department Description: This position will be providing support on the Beth Israel Lahey Health Credentialing Verification Office team.

Job Location: Burlington, MA

Req ID: 41226BR


Job Summary: 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.

Essential Responsibilities:
  1. 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.
  2. 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.
  3. 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.
  4. Appropriately and timely communicate with assigned medical staff offices.
  5. Timely and accurately prepare credential files for audit and submission to assigned hospitals.
  6. Compliance with standard turn-a-round times.
  7. Maintain a working knowledge of relevant regulatory standards (i.e., TJC and NCQA), state and federal requirements, and applicable Medical Staff Bylaws.
  8. Assist with the development and implementation of credentialing and re-credentialing workflows to ensure efficient and effective alignment of processes and assists in the development or revision of credentialing related forms.
  9. Participation in special project teams as assigned.
Required Qualifications:
  1. High School diploma or GED required.
  2. 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.
  3. 1-3 years related work experience required in CVO or Medical Staff Services in an acute healthcare setting.
  4. Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.
Preferred Qualifications:
  1. Knowledge of credentialing software and associated applications.
  2. Experience with credentialing and privileging.
Competencies:
  1. Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.
  2. Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.
  3. Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager.
  4. Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers.
  5. Oral Communications: Ability to comprehend and converse in English to communicate effectively with medical center staff, patients, families and external customers.
  6. Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.
  7. Team Work: Ability to work collaboratively in small teams to improve the operations of immediate work group by offering ideas, identifying issues, and respecting team members.
  8. Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations.

Physical Nature of the Job:
Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally
EOE Statement

BIDMC is EOE M/F/VET/DISABILITY/GENDER IDENTITY/SEXUAL ORIENTATION

Vaccines

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. BILH requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more about this requirement

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