Kaiser Permanente-posted 3 months ago
Portland, OR
Ambulatory Health Care Services

The position involves independently requesting and reviewing primary source information and verifications, identifying and planning for resolution of moderately complex gaps in vendor relationships, and serving as a main point of contact for external queries regarding practitioner status. The role includes evaluating applications and supporting complex documents, suggesting improvements to credentialing and privileging processes, and evaluating moderately complex practitioner sanctions. The individual will participate in surveys and audits of credentialing entities, facilitate cost-effective due process, conduct audits of data between different departments, and provide orientation and training to newly appointed physician leaders. The position also requires maintaining working relationships with key stakeholders and processing moderately complex provider enrollment information.

  • Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members.
  • Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers.
  • Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses.
  • Facilitates team collaboration to support a business outcome.
  • Completes work assignments autonomously and supports business-specific projects.
  • Collaborates cross-functionally and/or externally to achieve effective business decisions.
  • Supports the development of work plans to meet business priorities and deadlines.
  • Identifies, speaks up, and capitalizes on improvement opportunities across teams.
  • Participates in training and regulatory awareness.
  • Ensures quality assurance, improvement, and resolution by evaluating practitioner sanctions and complaints.
  • Processes provider enrollment by gathering and reviewing information for enrollment applications.
  • Conducts primary source verification and management.
  • Conducts database management by maintaining data within a computerized database.
  • Applies and ensures control and application of data systems.
  • Enacts and analyzes data to support knowledge management and record-keeping.
  • Enacts credentialing and privileging maintenance and management.
  • Minimum one (1) year(s) of experience in a leadership role with or without direct reports.
  • Minimum two (2) years of experience with databases and spreadsheets.
  • Bachelor's degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field AND minimum three (3) years of experience in clinical credentialing, accreditation and regulation, licensing, health care, quality, or a directly related field OR minimum six (6) years of experience in clinical credentialing, accreditation and regulation, licensing, or a directly related field.
  • Provider Credentialing Specialist Certificate within 36 months of hire.
  • Knowledge of negotiation and compliance management.
  • Experience in health care compliance and data analytics.
  • Skills in consulting and managing diverse relationships.
  • Project management experience.
  • Familiarity with health care quality standards and credentialing IT application software.
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