Corrections Specialist 3 - Credentialing Program Specialist - P019-HQ

State of Washington•Thurston County – Tumwater, WA

5d•Onsite

About The Position

The Department of Corrections is seeking a motivated project position for the Corrections Specialist 3 (CS3)-Credentialing Program Specialist to join our team. The Corrections Specialist 3 (CS3) serves as the senior-level Program Specialist within the Office of Quality, Governance, and Accountability. Reporting to the Health Services Credentialing Program Manager, this position independently performs complex duties to manage and implement the Department’s healthcare provider enrollment and credentialing programs. This role has overall responsibility for the technical coordination of enrollment within the DOC Health Services Division. This includes evaluating and verifying practitioner credentials against federal and state guidelines, managing the integrity of the credentialing database, and interpreting RCW, WAC, and national standards to ensure team alignment. The CS3 analyzes complex metrics related to licensure compliance to identify trends and provides recommendations to leadership to mitigate institutional risk. Acting with high-level autonomy, this position collaborates across disciplines—including Nursing, Behavioral Health, and Medical Services—to lead Health Services divisional readiness and ensure patient safety initiatives. The CS3 serves as a technical advisor & specialist in building governance structures and providing specialized consultation on adverse event reviews and policy development. By ensuring clinical staff meet rigorous qualifications, this position directly enables the delivery of constitutionally mandated care in accordance with RCW 72.10 and the DOC Health Plan.

Requirements

4 years of professional experience providing healthcare case management services in adult or juvenile corrections, social services, or closely related field
2 years working with Medicaid systems.
Supervisory Experience
Proficiency using Microsoft Office software (Word, Excel, Outlook).
Excellent written and verbal communication skills
Must be able to work in spaces, climb stairs, walk long distances, and frequently lift up to 30 pounds.
Under rare circumstances this position may be required to lift or carry up to 50 pounds and push up to 100 pounds.

Nice To Haves

Relevant work experience in healthcare or administrative roles.
Certification in credentialing, such as the Certified Provider Credentialing Specialist (CPCS) from NAMSS or willing to work towards certification
Strong communication skills and attention to detail, essential for managing the credentialing process.
Familiarity with credentialing software and databases used in healthcare settings.
Bachelor’s degree in healthcare administration, business or related field.

Responsibilities

Serves as the senior program specialist responsible for the coordination and maintenance of ProviderOne enrollment for all licensed employees and contract staff within the Health Services division.
Independently manages the end-to-end lifecycle for initial and continuous provider enrollment within ProviderOne.
Coordinates and monitors the review and analysis of practitioner applications and primary source documents to verify and ensure applicant eligibility.
Evaluates and confirms provider eligibility to participate in Federal programs (Medicaid) and ensures all practitioners possess a valid National Provider Identifier (NPI).
Independently monitors and maintains ProviderOne domains and provider records to ensure data accuracy and system security.
Serves as the point of contact to coordinate with the Health Care Authority (HCA) Provider Enrollment Team to resolve complex enrollment or system issues.
Ensuring all requests for provider information are completed in a timely manner and in strict compliance with federal and state regulatory standards.
Performs complex duties to implement and monitor the credentialing, privileging, and certification systems for Health Services staff.
Executes the primary source verification process by conducting background investigations and researching credentialing files to determine the accuracy of practitioner qualifications.
Reviews and ensure all eligible employees maintain current license and certification credentials in accordance with Federal, State, and Department requirements.
Manages and protects the confidentiality of state licenses, DEA certificates, and board certifications; ensures all required credentialing documents are secured.
Collaborates with Nursing, Behavioral Health, Medical Services, and Operations to ensure Health Services Division compliance with credentialing standards and patient safety protocols.
Notifies supervisor of credentialing and/or collaboration issues, or HSA in the absence of the manager.
Ensures all provider enrollment and credentialing activities comply with RCW 72.10, the DOC Health Plan, and DOH/HCA requirements.
Maintains and audits Managed Care Organization (MCO) provider rosters to ensure divisional accuracy and defensibility.
Conducts monthly audits of the Office of Inspector General (OIG) Exclusion List to mitigate agency risk.
Performs complex queries and generates reports for the National Practitioner Data Base (NPDB), American Medical Association (AMA), and SAM.gov in accordance with the Health Care Quality Improvement Act (HCQIA).
Identifies issues requiring specialized investigation; validates discrepancies and determines appropriate follow-up actions for the Credentialing Manager.
Represents the unit or supervisor at meetings and workgroups as a technical advisor and specialist.
Completes required annual AIS training and other mandatory professional development.
Performs other related work as required by the Health Services Division.