Credentialing Specialist II

At WHA, we're a team, passionate about humanizing healthcare. We're inspired by the diverse stories, strength and resilience of our patients and the unique choices they make in pursuing health for themselves and their families. We envision a world where every person has the opportunity to achieve their optimal health and we're here to support that journey with personalized, culturally competent care and knowledge.

The Credentialing Specialist II performs processes as necessary to complete and maintain credentialing, re-credentialing, revalidation, and privileging. This position is primarily remote, with occasional on-site attendance.

Duties:

• Communicates with clinicians, clinician licensing authorities, hospitals and other outside agencies.
• Protects clinician confidentiality by transmitting personal or sensitive information via secure email, fax or encrypted portal.
• Maintains individual provider records utilizing direct clinician feedback to ensure file completeness, accuracy and compliance with quality standards.
• Ensures credentialing application and renewal processes are tracked. Performing consistent and timely follow-up as applicable to ensure processes are complete. Escalates to Credentialing Specialist III when processes are delayed.
• Creates (when necessary) and maintains CAQH provider profiles through account audits and validation.
• Completes review of health plan rosters and clinician demographic information in a timely manner according to CMS mandate and No Surprises Act.
• Performs credentialing clinician offboarding and name change processes.
• Prepares and routes employment history verification and collaborating physician forms as necessary.
• Manages the processes for credentialing applications, i.e. generating clinical activity reports, verifying credentials and communicating externally as applicable for health plan and hospital credentialing processes.
• Responds to inquiries/request for information from internal and external sources. Escalating complex inquiries to Credentialing Specialist III.
• Works in coordination with the Patient Financial Services department for resolution of conflicting credentialing status information within payer networks.
• Completes professional liability application process with onboarding clinicians, assists with the annual renewal processes, and maintains relevant files.
• Works with Risk and Compliance Manger in coordination with HR, and as applicable Accounting, to relay practice changes to professional liability carrier. Including, but not limited to, Leaves of Absence, scope of practice, and FTE level changes.
• Utilizes internal systems and workflows in accordance with WHA credentialing policy to meet credentialing accreditation standard for WHA In-Office Surgery program.
• Initiate and obtain Primary Source Verification (PSV) documentation as outlined in WHAs Clinician Credentialing and Privileging for In-Office surgery and Peer Review policy.
• Acts as a liaison for payment of payable/reimbursable expenses between onboarding clinicians or other external contacts and WHA Accounting team. Tracking processes to provide status updates as needed.
• Assists with tracking and communicating clinician privileging conditions and facility proctoring requirements.

QUALIFICATIONS

• High school diploma or GED required.
• At least one year of experience in credentialing is required.
• High proficiency with various credentialing platforms (CAQH, PECOS, NPPES, I&A, CredentialStream, Legacy and Providence application systems).
• Proficient use of Adobe Acrobat Pro and PDF document editing abilities.

Salary Range/Equity Pay Analysis: Please note per the Oregon State Pay Equity Law your salary is determined based on the experience and education listed in your resume/application. It is strongly encouraged to include any transferable experience to ensure your offer is reflective of all directly related and equivalent experience. Please be specific with dates of positions, skills, and educational experiences related to the job you are applying for within your application materials.

WHA is 2023's #1 Largest Women-Owned Business in Oregon and Clark and Skamania Counties from the Washington-Portland Business Journal.

Women's Healthcare Associates, LLC is an equal opportunity employer.

Oregon employers are required by a number of state and federal agencies to display a variety of workplace notices and posters, including:
Federal Family and Medical Leave Act
https://www.dol.gov/whd/regs/compliance/posters/fmlaen.pdf