Credentialing Specialist

**Credentialing Specialist (Remote)**
- (3290377)

As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women’s Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care, and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.

We’re focused on a people-first culture for our system’s patients and our professional family. That’s why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees’ personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development—and we recognize success at every step.

Our employees use the Mass General Brigham values to govern decisions, actions, and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.

**General Summary**

Responsible for the administrative duties required in the credentialing verification process. Reviews, enters, and maintains specialized applicant information in a complex database and coordinates the credentialing process for the Medical Staff offices of the respective entities. Ensures the credentialing process complies with organizational as well as an accrediting agency, Federal, and State regulatory standards. Works in a team environment within the department and with the Medical Staff offices.

**Duties & Responsibilities**

**Responsible for the following steps of the credentialing process**:

- Processing of departmental credentialing requests, in accordance with established procedures and time frames.
- Preparation of reappointment packets for assigned area of responsibility.
- Initiation of the verification process within established time frames.
- Conducts follow-up on missing data and/or discrepancies in accordance with established time frames.
- As responses to verification requests are received, compare the responses with the information provided by the applicant to ensure accuracy and completeness.
- Works to ensure the verification process is completed within established time frames to allow entity to time to complete the committee reviews prior to appointment/next reappointment date.
- , Informs entity contacts and CCO team lead/manager, of the verification status of applicants, including providing updates on any potential problems identified during the verification process in accordance with established procedures and time frames
- Provides timely resolution of any verification problems/ discrepancies in order to ensure timely completion of the verification process.
- Keeps applicants (initial and reappointment) informed of the status of credentialing process which includes timely use of all correspondence as well as proper notification to the applicant.
- Serves as a liaison with Medical Staff Offices and other internal/external customers as it relates to practitioner related issues and concerns.

**Data management, administrative responsibilities**:

- Maintains an electronic record/file for all practitioners within the credentialing database giving attention to operational concerns and the need for others to retrieve the same records.
- Responsible for notifying manager when a policy or procedure is found to be in need of revision due to changes in laws/regulations, inaccurate, or unable to be accomplished as written.
- Maintains integrity of electronic, specialized database, which includes the importing of practitioner information in accordance with departmental policies and procedures.
- Utilizes appropriate database tracking reports to ensure accuracy and thoroughness of data entry documentation.
- Documents interactions with internal and external customers as appropriate within the appropriate fields of the credentialing database.
- Assists with the development and revision of the credentialing and audit workflows within the credentialing database.

**Training and development**:

- Maintains competency on vendor database via participation in online education learning modules and monthly skills related webinars
- Maintains competency in nationally recognized credentialing-related initiatives through participation with NAMSS and MAMSS, journal articles, and other industry-related news.
- Participates in the orientation of