[Hiring] Privileging and Credentialing Operations Specialist @Monogram Health

Role Description

Monogram Health is seeking a Privileging & Credentialing Operations Specialist to support external hospital and facility privileging and affiliations tied to strategic organizational initiatives. The ideal candidate is an experienced medical staff services professional with strong knowledge of hospital credentialing practices, affiliation levels, and specialized privileging requirements, and a talent for in-depth research and learning quickly. This role operates in a dynamic environment, and responsibilities may evolve based on organizational priorities, market expansion, operational needs, and strategic initiatives.

The Specialist will submit and track medical staff applications for EMR access, initial appointments and reappointments, serve as an in-house subject matter expert, and help management develop best practices in compliance with state, regulatory, and accrediting body standards. The role also coordinates workflows, trackers, and reporting across Licensing, Provider Enrollment, Primary Source Verification (PSV), and Privileging, and keeps executive leadership informed of status and projected timelines.

Responsibilities

• Prepare and submit accurate, complete medical staff and privileging applications, including EMR access, initial appointments and reappointments, to hospitals and affiliated healthcare facilities.
• Tailor each application to the facility's affiliation level, privileging requirements, and standards, and confirm alignment with regulatory standards and Monogram Health policies.
• Work closely with clinicians to obtain the information and documentation needed for successful submissions.
• Serve as the primary point of contact between Monogram Health and hospital credentialing offices.
• Follow up proactively on every application through completion, expedite approvals, and communicate status, outstanding items, and roadblocks.
• Report status and projected timelines to executive leadership and escalate roadblocks as needed.
• Complete ad hoc privileging research requests for strategic initiatives.
• Coordinate and monitor workflows across Licensing, Provider Enrollment, PSV, and Privileging, ensuring work is accurately assigned, sequenced, and on schedule.
• Act as liaison to resolve gaps, delays, and misalignments.
• Manage centralized intake and workload trackers (Smartsheet and credentialing database), practitioner status rosters, and offboarding trackers.
• Support onboarding and offboarding documentation, including DocuSign packets, and update forms, trackers, and workflows as processes evolve.
• Document status and notations in the credentialing platform, and keep organized records of submissions and supplemental documents in credentialing software and local drives.
• Maintain notes on process details, issues, and time metrics to support KPIs and future projections.
• Pull system reports to manage daily workflow and priorities.
• Prepare and distribute weekly leadership reports, and generate ProviderTrust Credentialing reports twice monthly for Compliance, validating data accuracy before distribution.
• Conduct routine data integrity audits and complete monthly Ongoing Monitoring in accordance with compliance requirements.
• Participate in cross-functional projects to improve efficiency and compliance, and follow Monogram Health credentialing policies and procedures.
• Provide backup support for payer enrollment and internal credentialing as needed. Cross-training will be provided by management.
• Support additional credentialing, provider operations, and strategic initiatives as needed. Workload is volume-dependent and varies with market expansion and internal business needs.

Qualifications

• High school diploma or GED required. Bachelor's degree or equivalent experience preferred.
• Certification as a Certified Provider Credentialing Specialist (CPCS) or Certified Professional in Medical Services Management (CPMSM) is a plus.
• Minimum of three (3) years of progressively responsible experience in medical staff services, provider credentialing, hospital privileging, healthcare operations, or healthcare compliance.
• Demonstrated understanding of hospital credentialing, affiliation levels, and privileging standards, including NCQA and Joint Commission credentialing requirements.
• Proficiency in Microsoft Office (particularly Excel and Word), Adobe Acrobat, DocuSign, and Smartsheet, and familiarity with credentialing software.
• Ability to independently manage multiple time-sensitive application processes at once, keeping all submissions well documented and on track for completion.
• Demonstrated research and analytical skills, with the ability to draw conclusions from data.
• Effective communication and relationship-building skills with hospital credentialing departments, providers, leadership, external agencies, and internal stakeholders.
• Adaptability and comfort with change, including willingness to shift focus, take on new tasks, and adjust to evolving priorities and processes.
• Proven organizational skills and attention to detail, with the ability to interpret regulations and handle confidential information with discretion.
• Professionalism, poise, and strong critical thinking, judgment, and decision-making skills.

Benefits

• Comprehensive Benefits: Medical, dental, and vision insurance, employee assistance program, employer-paid and voluntary life insurance, disability insurance, plus health and flexible spending accounts.
• Financial & Retirement Support: Competitive compensation, 401k with employer match, and financial wellness resources.
• Time Off & Leave: 20 PTO days, 7 paid holidays, and 1 floating day to make your own, and paid parental leave.
• Wellness & Growth: Work life assistance resources, physical wellness perks, mental health support, employee referral program, and BenefitHub for employee discounts.