Credentialing Specialist

As a Credentialing Professional, you will be responsible for coordinating the credentialing, re-credentialing, and payer enrollment process for providers in accordance with delegated credentialing agreements, policies and procedures, industry best practices, and regulatory requirements.

Every day you will manage daily credentialing operations, including resolution of non-responsive providers. You will also work collaboratively with various clinic managers and the hospital medical staff office to ensure the successful and timely completion of the delegated credentialing and re-credentialing process.

To be successful in this role, you will demonstrate a comprehensive understanding of credentialing regulations and processes, possess strong organizational and communication skills, and effectively manage complex administrative tasks to ensure provider compliance and efficient operational flow.

Essential Functions include but are not limited to: 

• Performs credentialing and re-credentialing processes according to departmental policies and procedures, various accreditations standards, health plan, state and Federal requirements.
• Receives and reviews submitted applications for completeness and compliance with instructions for preparation; ensures the timely completion of applications by communicating with and assisting the applicants in submitting all documentation necessary to process the application; identifies deficiencies and follows up to gather missing or incomplete data.
• Verifies all information (i.e., education/experience, training, qualifications, current/past affiliations, licensure, etc.) contained in the credentialing application to ensure that it is timely and accurate; requests and obtains documentation from a variety of sources (i.e., licensing agencies, educational institutions, insurance carriers, previous employers, etc.) in accordance with established procedures; obtains information regarding complaints and/or medical malpractice claims history; follows up as necessary to gather clarifying data; identifies problematic information and refers to higher level authority.
• Uses discretion and independent judgment in determining the need for deviation from standard processes or more detailed investigation, including those involving fees, or that would cause processing delays in order to clarify, verify and/or confirm information contained in the credentialing application.
• Provides assistance and guidance to physicians and professional providers through the hospital privileging processes.
• Produces verification letters and prepares files containing all required supporting documentation; sends completed application files to Medical Staff Office for review.

Required

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

Preferred

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

Virginia Mason Franciscan Health has a rich history of providing exceptional healthcare, dating back to 1891. Building upon a legacy of compassionate care and innovation, our organization has evolved over the years through strategic partnerships and integrations to expand our reach and services across the Puget Sound area.

Today, as Virginia Mason Franciscan Health, we remain deeply committed to healing the whole person – body, mind, and spirit – in the communities we serve. This commitment is strengthened by the diverse expertise and shared values brought together through our growth.

Our dedicated providers offer a full spectrum of health care services, from routine wellness to complex disease management, all grounded in rigorous research and education. Our comprehensive network of 10 hospitals and nearly 300 care sites strategically located across the greater Puget Sound region reflects our ongoing commitment to accessibility and comprehensive care.

We are proud of our pioneering medical advances and numerous awards and accreditations that reflect our dedication to excellence. When you join Virginia Mason Franciscan Health, you become part of a team that delivers top-quality, professional healthcare in modern, well-equipped facilities, and contributes to a legacy of service built on collaboration and shared purpose.