Job description
The Credentialing Specialist is responsible for all aspects of initial credentialing, recredentialing, and privileging. Collect and verify sensitive provider and practitioner data through confidential sources. Maintain timely updates to information systems and regular reports used to monitor completion of applications. Audit files based on internal standards and regulatory requirements. Assist other internal departments with application completion and system coordination activity. Work independently with very little supervision to meet specified timeframes. Kaiser Permanentes culture of compliance requires all staff to integrate applicable laws, regulations, and contractual obligations as a part of their daily standard work to ensure that process results meet these obligations.
Essential Responsibilities:
- The Credentialing Specialist is responsible for all aspects of initial credentialing, recredentialing, and if applicable privileging of practitioners or providers within credentialing scope who are employed or contracted to provide care to Kaiser Foundation Health Plan of Washington members. Collect and verify provider and practitioner information through primary sources for initial appointment and for re-appointment within established timeframes and in accordance with the standards required by accrediting/regulatory agencies (CMS, DSHS, NCQA & JCAHO or DNV). Maintain confidentiality of provider files and all information related to the credentialing process. Audit files based on GH and regulatory standards. Audit applications for completeness, accuracy and essential criteria to meet required standards.
- Create and maintain credentialing database to keep data current and accurate. Run standard reports to monitor work and ensure completion of applications in a timely manner. Provide written and verbal communication with federal, state and local agencies, hospitals, medical review boards and malpractice carriers to obtain provider and practitioner information. Assess, evaluate and interpret application and verification information to identify red flags or areas of established non-compliance. Communicate adverse, incomplete, or questionable data to Medical Director, Credentials Committee Chair, or designee and recommend appropriate course of action. Maintain strict confidentiality and apply professional discretion when areas of concern are identified. Participate in preparation for internal and external audits conducted for current and accurate provider information or delegation compliance. Coordinate Credentialing Committee meetings and agendas, including minutes and follow up action
- Manage incoming and outgoing mail while meeting policy timelines and updating the credentialing database. Keep Track of pended information and follow up in an appropriate timeframe. Provide assistance with special projects. May scan working documents, make copies, assist with mass mailings, distribute faxes and/or help file correspondence and pertinent materials. Participate in research, review and interpretation of applicable accreditation, licensing, and other regulatory requirements to ensure credentialing policies and policies continually meet requirements. Participate in design and development of forms to support credentialing process.
- Assist other internal departments, with application completion and systems coordination activity. Provide status reports and communicate practitioner participation information to internal and external customers. Maintain written and verbal communication with Credentialing Committee members and Board of Trustees.
Basic Qualifications:
Experience
- N/A
Education
- Associates degree OR two (2) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- N/A
Additional Requirements:
- Demonstrated ability to manage multiple priorities and competing deadlines.
- Basic computer skills, with Proven knowledge of database creation and maintenance and MS Work.
- Communication Skills
Preferred Qualifications:
- Experience in managed care, hospital or medical office environment.
- Bachelors degree with coursework in health care
PrimaryLocation : Washington,Renton,Renton Administration - Glacier
HoursPerWeek : 40
Shift : Day
Workdays : Mon, Tue, Wed, Thu, Fri
WorkingHoursStart : 08:00 AM
WorkingHoursEnd : 04:30 PM
Job Schedule : Full-time
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : NUE-WA-04|NUE|Non Union Employee
Job Level : Individual Contributor
Job Category : Health Care & Hospital Operations
Department : Renton Admin Glacier - Qlty Rsrc-Crdtlg-Regquant Rsk - 1130
Travel : No
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.
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