CVO Credentialing Specialist

Job description

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. 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. Exercises 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. Fosters a culture of excellence through effective communication, collaboration, and quality customer service, working closely with CVO and MSO leadership and staff as well as internal and external customers/stakeholders, providers, and clinical and administrative leaders throughout 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 with the CVO as well as with BILH affiliated organizations. Works to develop an overall singular culture of excellence and efficiency system wide. Job Description: Essential Duties & Responsibilities including but not limited to: Independently manages credentialing applications for initial appointment and reappointment, including application intake, validation, primary source verification, analysis, and ongoing status management. Conducts and evaluates primary source verification activities, performing detailed analysis of application and verification data to ensure accuracy, completeness, and compliance with regulatory, accreditation, and organizational requirements. Identifies, evaluates, and escalates red flag, adverse, or inconsistent information to CVO leadership in accordance with established policies, exercising sound professional judgment to support appropriate review and resolution. Maintains complete, accurate, and audit-ready electronic credentialing files, ensuring data integrity, documentation quality, and compliance with internal standards and external audit requirements. Ensures timely and accurate file completion in accordance with established turnaround time and service level standards. Ensures the integrity, accuracy, and timeliness of credentialing data entered into credentialing databases and associated systems. Prepares credentialing files for internal quality review, peer audit, committee consideration, and submission to assigned hospitals, ensuring adherence to established quality and timeliness standards. Participates in peer-to-peer file audits and quality review activities, contributing to consistency, compliance, and continuous process improvement across the CVO. Communicates effectively with leadership, Medical Staff Offices, and other stakeholders regarding application status, barriers, and resolution needs to support efficient workflow and service expectations. Maintains a working knowledge of applicable regulatory and accreditation standards (e.g., NCQA, The Joint Commission, DNV), state and federal requirements. Participates in special projects and cross-functional initiatives as assigned. C onsistently works toward achievement of individual, team, and departmental goals and performance metrics. ​ Minimum Qualifications: Education : Minimum: High School Diploma or equivalent required; Associate’s or Bachelor’s degree preferred Experience : Minimum: 1–3 years of healthcare administration, credentialing, provider enrollment or related experience' 2–4 years in a hospital MSO or CVO environment preferred Licensure, Certification & Registration : Preferred: NAMSS Certified Professional Credentialing Specialist (CPCS). Skills, Knowledge & Abilities: Working knowledge of credentialing standards and regulatory requirements (e.g., Joint Commission, DNV, CMS, NCQA, state regulations). Strong attention to detail, organizational, and time management skills. Ability to analyze information, identify issues, and exercise sound judgment. Excellent written and verbal communication and customer service skills. Ability to work independently and collaboratively in a fast-paced, deadline-driven environment. Proficiency with credentialing databases, electronic systems, and standard office software. Demonstrated ability to maintain confidentiality and handle sensitive information with discretion. Organizational Requirements: Maintain strict adherence to the BILH CVO Confidentiality policy. Incorporate BILH CVO Standards of Behavior and Guiding Principles into daily activities. Comply with all BILH CVO Policies. Comply with behavioral expectations of the BILH CVO. Maintain courteous and effective interactions with colleagues, providers, and BILH leadership. Demonstrate an understanding of the job description, performance expectations, and competency assessment. Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to BILH CVO customer service standards. Participate in departmental and/or interdepartmental quality improvement activities. Participate in and successfully completes Mandatory Education. Perform all other duties as needed or directed to meet the needs of the department. Pay Range: $31.48 - $41.73 The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. Compensation may exceed the base hourly rate depending on shift differentials, call pay, premium pay, overtime pay, and other additional pay practices, as applicable to the position and in accordance with the law. 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. 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