Credentialing Specialist

Location: Federal Way Administration, WA, 98003

Position Summary:

The Credentialing Specialist is responsible for ensuring the agency is always fully compliant with all state and federal regulations. The position includes keeping detailed records of employees, maintaining databases and ensuring staff members legal licenses and/or credentials are aligned and up to date with the latest medical policies and procedures.

Essential Job Functions:

• Manage the credentialing process for providers, including prescribers, nurses and other licensed and unlicensed professionals.
• Verify the accuracy and completeness of provider applications for all insurance lines of business, ensuring that all required documents are submitted.
• Responsible for timely updates to clinician rosters for all payors.
• Obtain and audit all required prescriber professional liability insurance documents for accuracy and completeness to be provided to Valley Cities insurance broker timely.
• Update all the provider data in the Electronic Health Record (EHR) system to ensure accurate information for billing and audit purposes.
• Facilitate the completion of thorough background checks, license verifications, and references to ensure compliance with regulatory standards.
• Coordinate with internal departments and external agencies to obtain and update relevant provider information.
• Maintain accurate and up-to-date electronic and hard copy files of all related documentation.
• Document and retain all attempts to address provider data discrepancies or missing information needed for accurate credentialing purposes.
• Monitor expiring licenses and credentials, proactively initiating the renewal process to avoid any disruption in services.
• Participate in the weekly new hire orientation to provide support and guidance to internal staff regarding credentialing process.
• Attend, participate and collaborate in all required meetings with both internal and external entities.
• Assist the UM Specialist as needed.

Qualifications and Skills:

• Bachelor’s degree in healthcare administration, business, or related field or minimum of 5 years of experience in credentialing and provider enrollment.
• The Certified Provider Credentialing Specialist (CPCS) designation is preferred but not required.
• Must have experience with credentialing in a medical or other healthcare setting.
• Knowledge of relevant federal and state regulations.
• Strong organizational and time-management skills.
• Excellent attention to detail.
• Strong communication and interpersonal skills.
• Experience with Microsoft Office Suite.
• Strong knowledge of industry regulations, such as The Joint Commission (TJC) standards.
• Ability to work independently and collaboratively within a team.

Working Conditions:

Work is performed inside and outside in varying temperatures. The employee may occasionally be required to push or lift to 25 pounds. May be exposed to office supply odors or vapors. The employee is sitting most of the time. The employee is also required to stand, walk, type, bend, write, read, interpret and explain complex issues and speak on the telephone.