Credentialing Specialist

CommonSpirit Health • Bremerton, WA

4h

About The Position

Virginia Mason Franciscan Health is seeking a Credentialing Specialist to coordinate provider credentialing, re-credentialing, and payer enrollment in accordance with delegated credentialing agreements, organizational policies and procedures, industry best practices, and regulatory requirements. The role manages daily credentialing operations, including resolving issues with providers who do not respond, and collaborates with clinic managers and the hospital medical staff office to complete delegated credentialing and re-credentialing accurately and on time.

The specialist supports providers through hospital privileging processes, prepares materials for credentialing committee review, maintains correspondence and credentialing records, assists with productivity reporting, and helps prepare for health plan delegation oversight audits. Success requires an understanding of credentialing regulations and processes, strong organizational and communication skills, and the ability to manage complex administrative work that supports provider compliance and efficient operations.

Requirements

• Two years of practitioner credentialing experience, or three years of administrative experience demonstrating the required job knowledge, skills, and abilities.
• Certified Provider Credentialing Specialist certification upon hire.

Nice To Haves

• Three years of administrative experience demonstrating the required job knowledge, skills, and abilities, preferably in a healthcare setting.

Responsibilities

• Coordinate provider credentialing, re-credentialing, and payer enrollment in accordance with delegated credentialing agreements, policies, best practices, and regulatory requirements.
• Manage daily credentialing operations, including resolution of non-responsive providers.
• Collaborate with clinic managers and the hospital medical staff office to complete delegated credentialing and re-credentialing in a timely manner.
• Perform credentialing and re-credentialing according to departmental policies and procedures, accreditation standards, and health plan, state, and federal requirements.
• Provide assistance and guidance to physicians and professional providers through hospital privileging processes.
• Prepare files, letters, and summaries for Medical Staff Office and/or Franciscan Medical Group Credentialing Committee review.
• Maintain written and verbal correspondence and data collection records regarding provider status and the credentialing process.
• Assist with productivity reporting.
• Assist in preparation for health plan delegation oversight audits.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed