Credentialing Specialist, Professional Staff Affairs

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

The Credentialing Specialist, Professional Staff Affairs, will support the Office of Professional Staff Affairs at Beth Israel Deaconess Medical Center in Boston, MA.

Once trained, this role can work remotely. Incumbent will begin training on an 8am - 4:30pm schedule, with some flexibility after trained to start earlier if preferred.

Job Description:

Beth Israel Lahey Health and the BIDMC Office of Professional Staff Affairs are devoted to consistently promoting a culture of Wellbeing, Empathy, Collaboration, Accountability, Respect, and Equity as outlined in our organization's WE CARE values.

In this role, you will ensure accurate, reliable, and compliant credentialing, privileging, and peer review processes for medical staff. This role supports regulatory readiness, data integrity, and professional practice evaluation in alignment with Joint Commission, CMS, MA DPH, NCQA, and payer requirements.

This position demands exceptional attention to detail and a commitment to high reliability in managing complex privileging requirements across 13 clinical departments and approximately 60 divisions. It encompasses multiple high-acuity programs and specialized disease centers, ensuring full compliance with diverse regulatory standards and program-specific requirements.

The Specialist plays a critical role in supporting various medical staff leaders and committees throughout the credentialing and privileging decision-making process by identifying red flags in credentials files, ensuring accurate presentation of information, and validating completeness of reviewer feedback.

ESSENTIAL DUTIES & RESPONSIBILITIES (including but not limited to):

Credentialing & Data Integrity

• Perform rigorous quality checks on credentialing files and evaluate completeness of primary source verification conducted by the Credentialing Verification Organization (CVO).
• Maintain accurate provider data in MD-Staff and ensure integration with Workday for HR and learning management functions.
• Interpret and apply complex privileging criteria for advanced clinical programs and disease-specific centers, ensuring providers meet all minimum qualifications and program-specific standards.
• Review requested clinical privileges for appropriateness and minimum qualifications.
• Track privilege-specific training requirements for individual medical staff members.

Regulatory & Accreditation Compliance

• Navigate and apply requirements from Joint Commission, CMS, MA DPH, NCQA, and delegated credentialing agreements with payers.
• Support regulatory readiness for Joint Commission disease-specific care certifications (e.g., Stroke, VAD), CMS Conditions of Participation, and other program-specific audits.
• Collaborate with clinical leadership to ensure credentialing compliance for high-acuity programs such as Level 1 Trauma and Heart Transplant.
• Prepare and maintain credentialing files to meet regulatory, accreditation, and contractual standards.
• Support delegated credentialing audits and ensure compliance with payer requirements.

Medical Staff Support & Evaluation

• Review and facilitate Initial Professional Practice Evaluations (IPPE) and Ongoing Professional Practice Evaluations (OPPE).
• Serve as a key resource for department and division chiefs during credentialing and privileging reviews by identifying red flags, ensuring accurate and complete information is presented, and confirming that reviewer feedback is comprehensive.
• Assist in preparing documentation and data for surveys and audits related to specialized programs and delegated credentialing requirements.
• Monitor and track medical staff compliance with administrative requirements.
• Provide consultative support to applicants, department staff, and medical staff committees regarding credentialing processes and timelines.

System Management & Process Improvement

• Maintain provider records in MD-Staff and ensure accurate integration with other hospital systems.
• Manage appointment cycles, clinical privileges, and department assignments in the credentialing system.
• Ensure accurate and appropriate display of provider credentials and clinical privileges in internal and external directories, including Find-a-Doc and ePriv
• Recommend and implement process improvements to enhance workflow efficiency, data quality, and compliance with complex privileging structures.

Additional Duties

• Demonstrate exemplary professional communication and collaboration