Credentialing Specialist

Baystate Health; Town of Springfield (WI); On-site; USD 60,000 - 71,000; Full time

Job summary

Baystate Health in Springfield, MA is seeking an experienced Credentialing Specialist to join our Central Verification Organization. You will manage initial credentialing and reappointment for physicians and staff, ensuring files are complete and compliant.

Responsibilities include primary source verification, risk flagging, and preparing materials for Credentials Committee approval. You’ll collaborate with clinical leaders and educate teams on credentialing systems while maintaining strict

Qualifications

• High school diploma or equivalent, required.
• 5+ years in a healthcare environment with relational databases and managing information in a fast-paced setting.
• Exceptional attention to detail and a commitment to accuracy.
• Strong analytical, critical-thinking, and problem-solving skills.
• Excellent organizational and time-management skills with the ability to manage multiple priorities and deadlines.
• Strong written and verbal communication skills.
• Ability to exercise independent judgment and make sound decisions within established guidelines.
• Ability to work effectively both independently and collaboratively with a multidisciplinary team.
• Ability to manage assigned work with minimal supervision while maintaining a high level of accuracy and follow-through.

Responsibilities

• Manage the initial credentialing and reappointment process for physicians and staff.
• Gather, verify, analyze, and evaluate provider information to ensure credentialing files are complete, accurate, and compliant.
• Conduct thorough primary source verification and follow up with providers, references, and internal or external sources to resolve gaps, discrepancies, and missing information.
• Identify and clearly communicate red flags, concerns, and potential areas of risk for review by medical staff leaders and committees.
• Prepare credentialing files and ensure they contain all required documentation and information for Credentials Committee review.
• Prepare temporary privileges when necessary and maintain organized, accurate, and confidential credentialing files.
• Ensure credentialing practices align with requirements from TJC, NCQA, Medicare COPs, Massachusetts Dept. of Public Health, MA licensing boards, and other bodies.
• Maintain current knowledge of credentialing regulations, medical staff bylaws, rules and regulations, policies, procedures, and institutional requirements across the Baystate Health system.
• Partner with Clinical Chairs, Chiefs, Division Chiefs, and other clinical leaders, providing guidance on credentialing requirements, identifying gaps and red flags, and supporting informed recommendations.
• Educate clinical leaders on how to effectively review credentialing files and use credentialing systems and modules to complete assessments and recommendations.
• Train other team members on credentialing processes and procedures as needed.
• Assist with regulatory audits, accreditation reviews, and compliance activities, including preparation for surveys and audits.
• Maintain strict confidentiality while handling highly sensitive provider information.
• Collaborate with CVO and Medical Staff Services colleagues to ensure consistent, accurate, and compliant credentialing practices.

Skills

Healthcare experience

Attention to detail

Analytical skills

Time management

Communication skills

Independent judgment

Teamwork

Multitasking

Education

GED or HiSET

Certified Professional Credentialing Specialists - National Association of Medical Staff Services

Tools

Relational databases

Job description

Baystate Health, a nationally recognized leader in healthcare quality and safety, is seeking an experienced Credentialing Specialist to join our Central Verification Organization in Springfield, MA.

RESPONSIBILITIES: The Credentialing Specialist manages the initial credentialing and reappointment of physicians and other healthcare professionals, ensuring provider files meet rigorous regulatory, accreditation, and medical staff requirements. This is a role where accuracy matters, attention to detail matters, and your work directly contributes to patient safety.

Key Responsibilities:

As a Credentialing Specialist, you’ll serve as a subject matter resource throughout the credentialing process and will:

• Manage the initial credentialing and reappointment process for physicians and other medical and associate professional staff.

• Gather, verify, analyze, and evaluate provider information to ensure credentialing files are complete, accurate, and compliant.

• Conduct thorough primary source verification and follow up with providers, references, and internal or external sources to resolve gaps, discrepancies, and missing information.

• Identify and clearly communicate red flags, concerns, and potential areas of risk for review by the appropriate medical staff leaders and committees.

• Prepare credentialing files and ensure they contain all required documentation and information for Credentials Committee review.

• Prepare temporary privileges when necessary and maintain organized, accurate, and confidential credentialing files.

• Ensure credentialing practices align with requirements from The Joint Commission (TJC), NCQA, Medicare Conditions of Participation, Massachusetts Department of Public Health, Massachusetts professional licensing boards, and other applicable regulatory bodies.

• Maintain current knowledge of credentialing regulations, medical staff bylaws, rules and regulations, policies, procedures, and institutional requirements across the Baystate Health system.

• Partner with Clinical Chairs, Chiefs, Division Chiefs, and other clinical leaders, providing guidance on credentialing requirements, identifying gaps and red flags, and supporting informed recommendations.

• Educate clinical leaders on how to effectively review credentialing files and use credentialing systems and modules to complete assessments and recommendations.

• Train other team members on credentialing processes and procedures as needed.

• Assist with regulatory audits, accreditation reviews, and compliance activities, including preparation for surveys and audits.

• Maintain strict confidentiality while handling highly sensitive provider information.

• Collaborate with CVO and Medical Staff Services colleagues to ensure consistent, accurate, and compliant credentialing practices.

SCHEDULE:

• Full-time

• Monday–Friday, 8:00am-4:30pm

LOCATION:

• 280 Chestnut St.

• Springfield, MA

QUALIFICATIONS:

• High school diploma or equivalent, required

• 5+ years of experience working in a healthcare environment, including experience working with relational databases and managing information in a fast-paced setting.

• Exceptional attention to detail and a commitment to accuracy.

• Strong analytical, critical-thinking, and problem-solving skills.

• Excellent organizational and time-management skills with the ability to manage multiple priorities and deadlines.

• Strong written and verbal communication skills.

• Ability to exercise independent judgment and make sound decisions within established guidelines.

• Ability to work effectively both independently and collaboratively with a multidisciplinary team.

• Ability to manage assigned work with minimal supervision while maintaining a high level of accuracy and follow-through.

Education:

GED or HiSET (Required)

Certifications:

Certified Professional Credentialing Specialists - National Association of Medical Staff Services

Compensation

Note: The compensation range(s) in the table below represent the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range. Actual salaries may vary by position and will be determined based on the candidate’s relevant experience. No employee will be paid below the minimum of the range. Pay ranges are listed as hourly for non-exempt employees and based on assumed full time commitment for exempt employees.

Minimum - Midpoint - Maximum

$52,540.00 - $60,382.00 - $71,406.00

Equal Employment Opportunity Employer

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.