In 2020 united in a fierce commitment to deliver the highest quality care and exceptional patient experience Virginia Mason and CHI Franciscan Health came together as natural partners to build a new health system centered around the patient: Virginia Mason Franciscan Health. Our combined system builds upon the scale and expertise of our nearly 300 sites of care including 11 hospitals and nearly 5000 physicians and providers. Together we are empowered to make an even greater impact on the health and well-being of our communities.

While you’re busy impacting the healthcare industry, we’ll take care of you with benefits that mayinclude health/dental/vision, FSA, matching retirement plans, paid vacation, adoption assistance, annual bonus eligibility, and more!

JOB SUMMARY 

This job is responsible for performing provider credentialing, enrollment and database maintenance processing based on department and organizational policy, procedure, and standards and guidelines set forth by The Joint Commission (TJC) and the National Committee for Quality Assurance (NCQA), URAC, State and Federal Government, and health plan payors.  Work includes responsibility for assuring accurate and timely: 1) credentialing and subsequent submission of provider information to support appointing and claims submission, 2) enrollment in health plan networks and 3) data entry of provider demographics.   

Incumbents are also accountable for: 1) remaining current on federal and state regulatory, licensure, certification and application requirements to include Medicare, DSHS, Federal and State L&I, NPDB, and HCQIA standards;  2) Remaining current on payer requirements and credentialing processes to include a working knowledge of TJC, NCQA and URAC accreditation standards and CMS guidelines; 3) maintaining professional and proactive relationships with providers, contracted payers, and stakeholders, including troubleshooting and responding to inquiries related to credentialing and/or privileging; and 4) contribute to policies and procedure updates, internal desktop procedures and workflows.

Education/Work Experience Requirements

Two (2) years practitioner credentialing experience, or three (3) years administrative experience, that demonstrates attainment of the requisite job knowledge skills/abilities, preferably in a healthcare setting.

Licensure/Certification

Certified Provider Credentialing Specialist (CPCS) preferred, or able to obtain within two years of meeting prerequisites.