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Credentialing Specialist II, Seattle, WA


Community Health Plan of Washington

Professional

Seattle, WA

November 27, 2019


Working Each Day to Make a Difference

At Community Health Plan of Washington, we’re driven by our belief that everyone deserves access to quality health care.

More than 25 years ago, we made a commitment to improve the health of our communities by making quality health care accessible to all Washington state residents.

We continue that pledge today by providing affordable comprehensive coverage to more than 315,000 individuals and families throughout the state.

  • We are a local not-for-profit health plan in Washington State.
  • We are committed to keeping Washington families healthy.
  • We connect our communities to the health resources they need.
  • We provide access to high-quality care for our members.
  • We connect and empower our members through technology.
  • The Community Health Centers we partner with strive to support members with a comprehensive mix of medical resources in one convenient location.
  • Our partnerships with Community Health Centers and our extended provider network help us improve the health care delivery system.

To learn more about how you can make a difference working at Community Health Plan of Washington, visit www.chpw.org.

Credentialing Specialist II

POSITION PURPOSE:

Responsible for performing credentialing activities to ensure that Community Health Plan of Washington has a provider network of the highest quality.

PRINCIPAL DUTIES:

  • Non-Exempt - Reporting to work on time and for all scheduled shifts is essential to this position.
  • Responsible for the timely entry, processing and tracking of credentialing files.
  • Review credentialing files for accuracy and completeness. Performs primary source verification of practitioner credentials following National Committee for Quality Assurance (NCQA) and Centers for Medicare & Medicaid Services (CMS) accreditation guidelines.
  • Monitor and assist further investigations as deemed necessary during the credentialing process by document evaluation, primary source verifications or as requested from Credentials Committee and Credentials Committee Chair.
  • Prepare initial credentialing and re-credentialing files for the Medical Director and/or the Credentials Committee.
  • Ability to complete a minimum of 100 practitioner and/or facility files per month and meet the departmental performance target.
  • Works closely with Provider Contracting and Provider Data Services to ensure the credentialing application process is efficient and meets established turnaround times.
  • Attend monthly Credentialing Committee meetings and act on the decisions of the committee regarding files processed.
  • Attend and participate in bi-weekly Credentialing staff meetings.
  • Initiate provider file updates using the PACT form as required.
  • Maintain confidential credentialing files and electronic credentialing database.
  • Participate in credentialing team quality audits.
  • Participate in the development and implementation of departmental policies, procedures, forms, etc.
  • Perform site visits as necessary or requested.
  • Ability to report to work on time and work the days scheduled is essential to this position.
  • Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

QUALIFICATIONS:

Education:

  • High School diploma or equivalent required. Associate degree preferred.
  • Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) preferred. If not certified, must obtain certification within one year of hire date.

Prior Related Experience:

  • Minimum four (4) years’ experience in a healthcare delivery environment or three (3) years in credentialing activities.

Employment Eligibility:

  • Complete and successfully pass a criminal background check.
  • Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.

Knowledge, Skills, and Abilities:

  • Good oral and written communication skills.
  • Ability to meet scheduled deadlines with minimal supervision.
  • Strong organizational skills and accurate work results.
  • Ability to maintain a professional demeanor and confidentiality.
  • Maintain knowledge of CMS, NCQA, State and Federal regulations related to health plan credentialing activities.
  • Detail oriented.
  • Accomplish responsibilities accurately and expeditiously.
  • Ability to multi-task and deal with complexity on a frequent basis.
  • Flexible, team player.
  • Self-starter and self-motivated, functions independently with minimal direction.
  • Word processing and database computer skills, including Word and Visual Cactus, preferred.
  • Must be able to work with a variety of people and circumstances.

To apply, please visit: http://www.chpw.org/careers/

We're committed to our employees and their family, which is why we offer benefits that, makes a difference in their lives. Paid time off, tuition reimbursement, community service hours, and transportation perks are just a few of the offerings of our comprehensive and competitive benefits program.

Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

Headquarters: 1111 3rd Avenue, Suite 400 Seattle, WA 98101


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