Company Overview
Virginia Mason Franciscan Health is a leading healthcare provider in Western Washington, formed by the union of two highly-regarded systems: CHI Franciscan and Virginia Mason. As the largest integrated health system in the region, we offer unparalleled access to care, with a team of 18,000 staff and nearly 5,000 employed and affiliated physicians. Across our 11 hospitals and nearly 300 care sites in the Puget Sound area, we are dedicated to delivering the safest, highest quality care through our expert and compassionate medical professionals.
Job Summary:
This position is responsible for provider credentialing, enrollment, and database maintenance, adhering to departmental and organizational policies, procedures, and guidelines established by The Joint Commission (TJC), the National Committee for Quality Assurance (NCQA), URAC, and federal and state governments and health plan payers. This includes ensuring accurate and timely: 1) credentialing and submission of provider information for appointment and claims processing; 2) enrollment in health plan networks; and 3) data entry of provider demographics.
The role also requires: 1) staying current on federal and state regulations, licensure, certification, and application requirements (Medicare, DSHS, Federal and State L&I, NPDB, and HCQIA standards); 2) staying current on payer requirements and credentialing processes, including TJC, NCQA, and URAC accreditation standards and CMS guidelines; 3) maintaining professional relationships with providers, payers, and stakeholders, including troubleshooting credentialing/privileging inquiries; and 4) contributing to policy and procedure updates, internal procedures, and workflows.
Qualifications:
Education/Work Experience:
Two (2) years of practitioner credentialing experience or three (3) years of administrative experience demonstrating the required job knowledge, skills, and abilities, preferably in healthcare.
Licensure/Certification:
Certified Provider Credentialing Specialist (CPCS) certification is preferred, or the ability to obtain it within two years of meeting prerequisites.