MED STAFF 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.

MED STAFF CREDENTIALING SPECIALIST

Job Description:

ESSENTIAL RESPONSIBILITIES:

• 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).

• Processes new appointments, reappointments, temporary privileges, category changes, and resignations in a timely and accurate manner.

• 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.

• Adheres to established workflows and complies with required credentialing file turnaround times.

• Assists the CVO, when needed, to follow up with providers regarding late application submissions or missing documentation.

• Performs timely follow-up on missing or incomplete information to ensure applications are processed efficiently.

• Prepares credentialing files accurately and in a timely manner for review by hospital leadership and obtains all required approvals.

• Effectively communicates, both verbally and in writing, with providers, hospital leadership, and staff involved in the credentialing process.

• 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.

• Updates and maintains provider electronic credentialing records, ensuring timely, accurate, and complete database entries.

• Assists with the preparation of materials for Credentials Committee and Medical Executive Committee meetings, including agendas, minutes, meeting materials, and credentialing lists.

• Prepares and sends appointment and reappointment approval letters following Board of Trustees approval, within 30 days.

• Prepares application request forms for submission to the CVO, as assigned.

• Responds promptly and professionally to telephone calls and email inquiries.

• Maintains current knowledge of relevant regulatory standards (e.g., TJC, NCQA), as well as state and federal requirements and applicable Medical Staff Bylaws.

• Assists in the development and implementation of credentialing and recredentialing workflows to ensure efficient and effective alignment of processes.

• Assists in the development and revision of credentialing-related forms.

• Compiles OPPE/FPPE data for all medical staff providers.

• Participates in special projects and team initiatives as assigned.

• Takes a proactive role in monitoring and supporting improvements in team productivity.

• Continually strives to achieve individual, team, and departmental goals.

• Provides support as needed for maintaining departmental on-call schedules and assisting with data entry in EPIC and related systems.

• Supports general administrative functions of the Medical Staff Office, including phone coverage, supply management, and responding to inquiries.

• Participates in special projects and performance improvement initiatives as assigned.

• 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:

• Strong organizational skills with exceptional attention to detail and accuracy.

• Excellent written, verbal, and interpersonal communication skills.

• Proficiency in credentialing software, Microsoft Office Suite, and database management.

• Ability to respond calmly and effectively to unexpected work demands, prioritize multiple tasks, and meet established deadlines.

• Sound judgment and discretion when handling confidential or sensitive information.

• Ability to work both independently and collaboratively in a fast-paced environment.