Credentialing Specialist I

About the Role

Processes applications for appointment, re-appointment, and mid-cycle change to the Medical Staff, House Staff, and Associate Clinical Staff, as well as requests for clinical privileges, in a customer-focused, efficient, comprehensive, timely, and accurate manner.

Responsibilities

• Review and evaluate applications, including evidence of education, training, experience, and competency, to determine eligibility for membership and clinical privileges.
• Obtain primary source verifications for all information submitted by the applicant or re-applicant.
• Recognize, investigate, and validate discrepancies and adverse information obtained from the application, primary source verifications, or other sources; obtain clarification and escalate concerns.
• Notify applicants, re-applicants, and their coordinators of any issues and maintain contact with them throughout the process.
• Compile, evaluate, and present practitioner-specific data collected for review by one or more decision-making bodies in a comprehensive and timely manner.
• Document, according to policy and procedure, applicants and re-applicants with potential issues in a holistic and comprehensive manner.
• Solicit and obtain information from the Department or Division Chief regarding applicants and re-applicants.
• Escalate concerns, according to policy and procedure, to the chain of command.
• Perform related credentialing functions, including ensuring all documents are maintained according to policy and procedure.
• Maintain confidential credentialing files for all applicants and members of the Medical Staff, House Staff, and Associate Clinical Staff.
• Enroll, maintain enrollment, and terminate members of the Medical Staff, House Staff, and Associate Clinical Staff with the appropriate institutional malpractice carrier.
• Provide the highest level of service to all customers (internal and external) as demonstrated through the core values of the enterprise.
• Implement office goals and objectives using continuous process improvement methods.
• Maintain relationships and serve as a liaison between Medical Staff Services and clinical departments and divisions, and their Chief(s), enterprise-wide, to address questions and concerns.
• Teach and provide expertise to managers, medical staff, and staff on credentialing processes, requirements, and regulations.
• Apply relevant Medical Staff Bylaws, Rules and Regulations, and any other relevant regulatory standards to the day-to-day functioning.
• Create a customer-friendly and healthy work environment in support of employee engagement and well-being.
• Assist in facilitating an efficient, productive, accountable, and customer- and quality-oriented work environment using high-reliability principles.

Requirements

• Associate’s degree in Medical Staff Services Science, Health Care Administration, or a closely related field, or one year of basic technical training.
• One year of related experience in a hospital or healthcare environment.
• One year of experience in credentialing, provider enrollment, or a closely related field.

Skills

• Attention to detail, managing multiple tasks simultaneously, identifying and escalating concerns, and meticulous organization.
• Effective oral and written communication, with the ability to exchange information on factual matters and provide tact and empathy in difficult interpersonal situations.

Candidates from the New England region preferred.

Pay

The posted pay range is Boston Children’s reasonable and good-faith expectation for this pay at the time of posting. Any base pay offer provided depends on skills, experience, education, certifications, and a variety of other job-related factors.

Benefits

• Flexible schedules.
• Affordable health, vision, and dental insurance.
• Child care and student loan subsidies.
• Generous levels of time off.
• 403(b) Retirement Savings plan and Pension.
• Tuition and certain License and Certification Reimbursement.
• Cell phone plan discounts.
• Discounted rates on T-passes.