Credentialing & Provider Enrollment Specialist
Sea Mar Community Health Centers
- Federal Way, WA
- $25.00-29.00 per hour
- Permanent
- Full-time
Annual Salary: $52,000 - $60,000This is an on-site office position, not remote.Position Summary:Sea Mar Community Health Centers seeks an experienced Credentialing & Provider Enrollment Specialist. This is a Full-time position (Monday-Friday) 8:00 am to 5:00 pm. The Credentialing Specialist be responsible for coordinating all aspects of the privileging and credentialing process for the licensed independent practitioners (LIPs) in accordance with the Policies & Procedures, national standards and regulatory requirements.Duties and Responsibilities:
- Maintain regular cooperation and compliance with all regulatory, accrediting, and membership-based organizations.
- Create and carry out various credentialing processes in relation to licensed providers in medical, dental and behavioral health departments.
- Ensure that all credentialed providers adhere to facility and staff policies, department guidelines, regulations, and government laws.
- Process applications and reappointment paperwork, checking for full completeness and accuracy.
- Perform provider credentialing/qualifying process to ensure all requirements are met in accordance with credentialing requirements prior to presentation to Board of Directors.
- Ensure that all credential files are current and complete pursuant to expiration date of medical licenses, board certification, professional-liability insurance coverage, DEA and other pertinent information, per HPP and/or client facility policy and procedures.
- Coordinate credentialing process by entering/logging/scanning information into MD Staff credentialing software for initial, updating, and add on applications and maintenance processes.
- Collect and verify sensitive provider data through confidential sources.
- Maintain timely updates to information systems and regular reports used to monitor completion of initial and reappointment credentialing applications.
- Audit files based on internal standards and regulatory requirements.
- Monitor and report application status and provide appropriate correspondence (form letters) to providers and department heads when necessary.
- Provide complete and accurate credentialing files to Administration for inclusion in Board of Directors’ materials.
- Working knowledge of Joint Commission, NCQA and CMS credentialing and privileging standards and experience with provider and health plan credentialing.
- Intermediate computer skills including Microsoft products and web based queries.
- Demonstrated ability to manage and meet multiple priorities and competing deadlines, problem solving and organization skills with attention to details. Experience with credentialing software is desirable, MD Staff preferred.
- Current NAMSS Certified Provider Credentialing Specialist (CPCS) or willing to begin actively pursuing certification upon hire.
- Previous work experience in managed care, hospital or medical office environment required.
- Experience with delegated health plan credentialing agreements preferred.
- Excellent verbal and written communication skills, including ability to compile, interpret, and utilize information; and to communicate effectively with people of all backgrounds and educational levels.
- Ability to work with minimal supervision, use good judgment, meet deadlines, and prioritize workloads.
- Ability to maintain confidentiality.
- Well organized and have good attention to detail.
- Computer literate and have good mathematical skills. Experience in Windows Office programs and data entry preferred.
- Ability to solve problems and reason deductively.
- College degree preferred, high school diploma acceptable if previous work experience in managed care, hospital or medical office environment.
- Ability to fluently speak and read English required; bilingual English/Spanish preferred.
- Healthcare billing experience
- Payer relations, enrollment, and reimbursement
- Knowledge of medical terminology
- Insurance verification
- Health plan contracts
- Exposure to Medicaid and Medicare plans and programs
- Understanding of healthcare compliance
- Medical Staff Services experience
- Hospital privileging
- One Health Port (OHP) and Provider One.