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. 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. Job Description: 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 with providers, department leaders, and cross-functional teams to foster alignment, build trust, and promote a positive, respectful culture across the organization. Provide coverage and support for other Specialists to ensure uninterrupted process flow. Perform other tasks as assigned to support the medical staff and its committees. REQUIRED QUALIFICATIONS: High School diploma or GED required; Bachelor’s degree preferred. 3–5 years of related work experience in credentialing or medical staff services. Strong organizational skills, attention to detail, and ability to prioritize workload. Proficiency with credentialing software (e.g., Cactus) and Microsoft Office applications (Outlook, Word, Excel, PowerPoint). Working knowledge of regulatory and accreditation standards (Joint Commission, CMS, MA DPH, NCQA). Ability to interpret and apply complex privileging requirements. PREFERRED QUALIFICATIONS: Certification from the National Association of Medical Staff Services (CPCS or CPMSM) preferred. Experience supporting delegated credentialing audits and payer compliance. Experience with credentialing for complex privileging structures and high-acuity programs (e.g., trauma, transplant, disease-specific certifications) strongly preferred. Experience working in a high-reliability healthcare environment. OTHER REQUIREMENTS: Consistently promote a culture of Wellbeing, Empathy, Collaboration, Accountability, Respect, and Equity as outlined in the organization's WE CARE values. Demonstrated commitment and actions to valuing diversity and contributing to an inclusive working and learning environment This is a remote position but may require occasional on-site presence for meetings, etc. Sedentary work: May exert 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. Pay Range: $27.00 - $43.00 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