Credentialing Specialist

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 youll 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
• MondayFriday 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.

THE ADVANTAGES OF WORKING WITH BAYSTATE!

• Excellent Compensation High-quality low-cost medical dental and vision insurance
• Generous PTO up to 25 days in the first year with scheduled earned increases
• Continuing education support and reimbursement
• First Time Home Buyers Financial Packages
• Farm Share Memberships
• 403b retirement company match & annual company contribution increase based on years of service
• Free money coach advice from a certified professional
• Wellbeing programs that include but are not limited to mental physical and financial health
• Pet home auto and personal insurance
• Life insurance
• Reimbursement for a variety of wellbeing activities included but limited to gym membership and equipment personal trainer massage and so much more!
• Wellbeing programs that include but are not limited to mental physical and financial health

Education:

Certifications:

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 candidates 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

Equal Employment Opportunity Employer