Credentialing Specialist

VMFH Division Support Services; United States; On-site; USD 52,000 - 72,000; Full time

Job summary

Virginia Mason Franciscan Health is seeking a Credentialing Professional to manage credentialing, re-credentialing, and payer enrollment for providers in accordance with policies and regulatory requirements. You will ensure timely completion and collaborate with the hospital staff office to resolve non-responsive providers.

Responsibilities include preparing files and summaries for credentialing committees, maintaining records, and assisting with audits.

Qualifications

• Two (2) years practitioner credentialing experience or three (3) years administrative experience.
• Solid understanding of credentialing regulations and processes.
• Ability to manage non-responsive providers and maintain data records.

Responsibilities

• Performs credentialing and re-credentialing per policies and standards.
• Assists physicians and providers through privileging processes.
• Prepares files and summaries for Credentialing Committee review.
• Maintains written/verbal correspondence and data collection on provider status.
• Supports productivity reporting and readiness for audits.

Skills

Credentialing

Payer enrollment

Regulatory compliance

Organizational skills

Communication skills

Job description

Where You'll Work

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.

Job Summary and Responsibilities

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.

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

Job Requirements

Required

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

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