Credentialing Specialist I

Boston Children's Hospital; Boston (MA); On-site; USD 60,000 - 75,000; Full time

Job summary

Boston Children’s Hospital in Boston, MA is seeking a Credentialing Specialist to process appointments, re-appointments, and mid-cycle changes for Medical Staff, House Staff, and Associate Clinical Staff, ensuring timely and accurate credentialing and privilege requests.

You will verify education and experience, obtain primary source verifications, identify discrepancies, communicate with applicants, and support decision-making bodies with data, all while maintaining confidential files and

Qualifications

• 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 closely related field.

Responsibilities

• Reviewing and evaluating applications, including evidence of education, training, experience, and competency, to determine eligibility for membership and clinical privileges.
• Obtaining primary source verifications for all information submitted by the applicant or re-applicant.
• Recognizing, investigating, and validating discrepancies and adverse information obtained from the application, primary source verifications, or other sources; obtaining clarification and escalating concerns.
• Notifying applicants and re-applicants, and their coordinators, of any issues and maintaining contact with them throughout the process.
• Compiling, evaluating, and presenting practitioner-specific data collected for review by one or more decision-making bodies in a comprehensive and timely manner.
• Documenting, according to policy and procedure, applicants and re-applicants with potential issues in a holistic and comprehensive manner.
• Soliciting and obtaining information from the Department or Division Chief regarding applicants and re-applicants.
• Escalating concerns, according to policy and procedure, to the chain of command.
• Performing related credentialing functions, including ensuring all documents are maintained according to policy and procedure.
• Maintaining confidential credentialing files for all applicants and members of the Medical Staff, House Staff, and Associate Clinical Staff.
• Enrolling, maintaining enrollment, and terminating members of the Medical Staff, House Staff, and Associate Clinical Staff with the appropriate institutional malpractice carrier.
• Providing the highest level of service to all customers (internal and external) as demonstrated through the core values of the enterprise.
• Implementing office goals and objectives using continuous process improvement methods.
• Maintaining relationships and serving as a liaison between Medical Staff Services and clinical departments and divisions, and their Chief(s), enterprise-wide, to address questions and concerns.
• Teaching and providing expertise to managers, medical staff, and staff on credentialing processes, requirements, and regulations.
• Applying relevant Medical Staff Bylaws, Rules and Regulations, and any other relevant regulatory standards to the day-to-day functioning.
• Creating a customer-friendly and healthy work environment in support of employee engagement and well-being.
• Assisting in facilitating an efficient, productive, accountable, and customer and quality-oriented work environment using high-reliability principles.
• Providing and ensuring the highest level of service to all customers (internal and external) as demonstrated through the core values of the enterprise.

Skills

Attention to detail

Multitasking

Communication skills

Empathy

New England regional preference

Education

Associate’s degree in Medical Staff Services Science / Health Care Administration or related field

Job description

Position Summary

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

Position Summary

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

Key Responsibilities

• Reviewing and evaluating applications, including evidence of education, training, experience, and competency, to determine eligibility for membership and clinical privileges.
• Obtaining primary source verifications for all information submitted by the applicant or re-applicant.
• Recognizing, investigating, and validating discrepancies and adverse information obtained from the application, primary source verifications, or other sources; obtaining clarification and escalating concerns.
• Notifying applicants and re-applicants, and their coordinators, of any issues and maintaining contact with them throughout the process.
• Compiling, evaluating, and presenting practitioner-specific data collected for review by one or more decision-making bodies in a comprehensive and timely manner.
• Documenting, according to policy and procedure, applicants and re-applicants with potential issues in a holistic and comprehensive manner.
• Soliciting and obtaining information from the Department or Division Chief regarding applicants and re-applicants.
• Escalating concerns, according to policy and procedure, to the chain of command.
• Performing related credentialing functions, including ensuring all documents are maintained according to policy and procedure.
• Maintaining confidential credentialing files for all applicants and members of the Medical Staff, House Staff, and Associate Clinical Staff.
• Enrolling, maintaining enrollment, and terminating members of the Medical Staff, House Staff, and Associate Clinical Staff with the appropriate institutional malpractice carrier.
• Providing the highest level of service to all customers (internal and external) as demonstrated through the core values of the enterprise.
• Implementing office goals and objectives using continuous process improvement methods.
• Maintaining relationships and serving as a liaison between Medical Staff Services and clinical departments and divisions, and their Chief(s), enterprise-wide, to address questions and concerns.
• Teaching and providing expertise to managers, medical staff, and staff on credentialing processes, requirements, and regulations.
• Applying relevant Medical Staff Bylaws, Rules and Regulations, and any other relevant regulatory standards to the day-to-day functioning.
• Creating a customer-friendly and healthy work environment in support of employee engagement and well-being.
• Assisting in facilitating an efficient, productive, accountable, and customer and quality-oriented work environment using high-reliability principles.
• Providing and ensuring the highest level of service to all customers (internal and external) as demonstrated through the core values of the enterprise.

Education:

• Associate’s degree in the field of Medical Staff Services Science, Health Care Administration or a closely related field, or one year of basic technical training

Experience:

• One year of related experience in a hospital or healthcare environment
• One year of experience in credentialing, provider enrollment or closely related field.

Knowledge, Skills, and Abilities:

• Attention to detail, managing multiple tasks simultaneously, identifying and escalating concerns, and meticulous organization.
• The ability to communicate effectively both orally and in writing, with the ability to exchange information on factual matters, as well as the ability to provide tact and empathy in difficult interpersonal situations.
• Candidates from New England region preferred.

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. Base pay is one part of a comprehensive benefits package that includes flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.