Credentialing Specialist

About This Role

Coordinating the credentialing, re-credentialing, and payer enrollment process for providers is the core of this role, ensuring compliance with agreements, policies, and regulatory requirements. This position involves managing daily credentialing operations and collaborating with clinic managers and the hospital medical staff office to ensure timely completion of processes.

Responsibilities

• Perform credentialing and re-credentialing processes according to departmental policies and procedures, accreditation standards, health plan, state, and Federal requirements
• Provide assistance and guidance to physicians and professional providers through the hospital privileging processes
• Prepare files, letters, and summaries for Medical Staff Office and/or Franciscan Medical Group (FMG) Credentialing Committee review
• Maintain all written/verbal correspondence and data collection records regarding provider status and credentialing process
• Assist with productivity reporting
• Assist in preparation for health plan delegation oversight audits

Requirements

• Two (2) years practitioner credentialing experience or three (3) years administrative experience, demonstrating attainment of the requisite job knowledge skills/abilities

Nice to have:

• Three (3) years administrative experience, demonstrating attainment of the requisite job knowledge skills/abilities, preferably in a healthcare setting
• Certified Provider Credentialing Specialist, upon hire

About the Company

Virginia Mason Franciscan Health has a rich history of providing exceptional healthcare, dating back to 1891. The organization has evolved through strategic partnerships and integrations to expand its reach and services across the Puget Sound area. Today, Virginia Mason Franciscan Health remains deeply committed to healing the whole person – body, mind, and spirit – in the communities it serves, with a comprehensive network of 10 hospitals and nearly 300 care sites.