When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.
Under the direction of the BILH Medical Staff Services Director, processes the appointment and reappointment applications for all members of the Medical Staff in accordance with State and Federal regulations and TJC standards. Facilitates the business of the clinical departments of the medical staff. Assists in performing the various operational functions of Medical Staff Services.Job Description:
Essential Duties & Responsibilities including but not limited to:
Independently manages credentialing applications for initial appointment and reappointment, including application intake, validation, primary source verification, analysis, and ongoing status management.
Conducts and evaluates primary source verification activities, performing detailed analysis of application and verification data to ensure accuracy, completeness, and compliance with regulatory, accreditation, and organizational requirements.
Identifies, evaluates, and escalates red flag, adverse, or inconsistent information to leadership in accordance with established policies, exercising sound professional judgment to support appropriate review and resolution.
Maintains complete, accurate, and audit-ready electronic credentialing files, ensuring data integrity, documentation quality, and compliance with internal standards and external audit requirements.
Ensures timely and accurate file completion in accordance with established turnaround time and service level standards.
Ensures the integrity, accuracy, and timeliness of data entered into databases and associated systems.
Prepares credentialing files for internal quality review, peer audit, committee consideration, and submission to assigned hospitals, ensuring adherence to established quality and timeliness standards.
Participates in peer-to-peer file audits and quality review activities, contributing to consistency, compliance, and continuous process improvement.
Communicates effectively with Medical Staff Service leadership and other stakeholders regarding application status, barriers and resolution needs to support efficient workflow and service expectations.
Maintains a working knowledge of applicable regulatory and accreditation standards (e.g., NCQA, The Joint Commission, DNV), state and federal requirements.
Participates in special projects and cross-functional initiatives as assigned.
Consistently works toward achievement of individual, team, and departmental goals and performance metrics.
Minimum Qualifications:
Education:
High School Diploma or equivalent required; Associate’s or Bachelor’s degree preferred.
Experience:
Minimum 1–3 years of healthcare administration, medical staff services, credentialing, provider enrollment or related experience; 2 years in a hospital MSO or CVO environment preferred.
Licensure, Certification & Registration:
NAMSS Certified Professional Credentialing Specialist (CPCS) preferred.
Skills, Knowledge & Abilities:
Working knowledge of medical staff/credentialing standards and regulatory requirements (e.g., Joint Commission, DNV, CMS, NCQA, state regulations).
Strong attention to detail, organizational, and time management skills.
Ability to analyze information, identify issues, and exercise sound judgment.
Excellent written and verbal communication and customer service skills.
Ability to work independently and collaboratively in a fast-paced, deadline-driven environment.
Proficiency with credentialing databases, electronic systems, and standard office software.
Demonstrated ability to maintain confidentiality and handle sensitive information with discretion.
Organizational Requirements:
Maintain strict adherence to the BILH Confidentiality policy.
Incorporate BILH Standards of Behavior and Guiding Principles into daily activities.
Comply with all BILH policies and with behavioral expectations of BILH.
Maintain courteous and effective interactions with colleagues, providers, and BILH leadership.
Demonstrate an understanding of the job description, performance expectations, and competency assessment.
Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to BILH customer service standards.
Participate in departmental and/or interdepartmental quality improvement activities. Participate in and successfully completes mandatory education.
Perform all other duties as needed or directed to meet the needs of the department.
Pay Range:
$31.63 - $41.73The 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.