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:
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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).
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Processes new appointments, reappointments, temporary privileges, category changes, and resignations in a timely and accurate manner.
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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.
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Adheres to established workflows and complies with required credentialing file turnaround times.
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Assists the CVO, when needed, to follow up with providers regarding late application submissions or missing documentation.
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Performs timely follow-up on missing or incomplete information to ensure applications are processed efficiently.
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Prepares credentialing files accurately and in a timely manner for review by hospital leadership and obtains all required approvals.
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Effectively communicates, both verbally and in writing, with providers, hospital leadership, and staff involved in the credentialing process.
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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.
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Updates and maintains provider electronic credentialing records, ensuring timely, accurate, and complete database entries.
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Assists with the preparation of materials for Credentials Committee and Medical Executive Committee meetings, including agendas, minutes, meeting materials, and credentialing lists.
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Prepares and sends appointment and reappointment approval letters following Board of Trustees approval, within 30 days.
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Prepares application request forms for submission to the CVO, as assigned.
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Responds promptly and professionally to telephone calls and email inquiries.
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Maintains current knowledge of relevant regulatory standards (e.g., TJC, NCQA), as well as state and federal requirements and applicable Medical Staff Bylaws.
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Assists in the development and implementation of credentialing and recredentialing workflows to ensure efficient and effective alignment of processes.
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Assists in the development and revision of credentialing-related forms.
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Compiles OPPE/FPPE data for all medical staff providers.
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Participates in special projects and team initiatives as assigned.
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Takes a proactive role in monitoring and supporting improvements in team productivity.
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Continually strives to achieve individual, team, and departmental goals.
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Provides support as needed for maintaining departmental on-call schedules and assisting with data entry in EPIC and related systems.
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Supports general administrative functions of the Medical Staff Office, including phone coverage, supply management, and responding to inquiries.
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Participates in special projects and performance improvement initiatives as assigned.
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Demonstrates flexibility and initiative in responding to changing departmental needs.
QUALIFICATIONS:
Education:
High school diploma or GED required; Associate’s or Bachelor’s degree preferred.
Certification:
CPCS (Certified Provider Credentialing Specialist) preferred.
Experience:
Minimum one (1) year of administrative or clerical experience in an acute healthcare setting or medical provider office required.
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.
Skills and Abilities:
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Strong organizational skills with exceptional attention to detail and accuracy.
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Excellent written, verbal, and interpersonal communication skills.
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Proficiency in credentialing software, Microsoft Office Suite, and database management.
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Ability to respond calmly and effectively to unexpected work demands, prioritize multiple tasks, and meet established deadlines.
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Sound judgment and discretion when handling confidential or sensitive information.
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Ability to work both independently and collaboratively in a fast-paced environment.
ADDITIONAL REQUIREMENTS:
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Maintains required competencies (both position-specific and hospital-wide).
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Performs all duties in compliance with hospital policies, safety standards, and applicable laws and regulations.
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May be required to perform similar or related duties as assigned or in response to departmental needs.
REMOTE WORK POLICY:
Eligibility for remote work is determined at the discretion of the Manager and must comply with the BILH Remote Work Policy.
Pay Range:
$26.44 – $43.27
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.
