Credentialing Specialist Print

Job Summary

The Central Business Office of Proliance Surgeons, Inc., is looking for a full-time Credentialing Specialist to join our Seattle office.

Job Description

Posted: 06/05/2019
Status: Full Time
Type: Administrative
Care Center: Proliance Surgeons, Inc.
City: Seattle, WA

The primary role of the credentialing specialist is to manage the daily workflow of credentialing and recredentialing applications with proficiency, accuracy and timeliness. This role participates in all aspects of initial credentialing, recredentialing and on-going monitoring for physicians and practitioners under established policies.

Essential Duties and Responsibilities:

  • Maintain comprehensive knowledge of credentialing standards, primary source verification process and the accepted sources and methods required to obtain necessary documentation
  • Work closely with the Chief Risk Officer to evaluate adequacy and information quality for effective and comprehensive peer review decision-making
  • Maintain on-going Monitoring Program per NCQA and CMS standards
  • Assist in annual review process for delegates to ensure timely credentialing pre-assessments, annual audits, file review, analysis, and written evaluation and ongoing follow up as applicable
  • Maintain basic knowledge of credentialing delegation; requirements, oversight and industry standard
  • Responsible for set up and maintenance of all credentialing files in an organized manner and closely monitor information collection and is cognizant of all information received and pursues additional information if necessary. Includes analyzing information per policy and NCQA & CMS standards
  • Responsible for tracking the credentialing expiration elements of all facilities, physicians and practitioners with accuracy and timeliness
  • Monitors system reporting for accuracy and assists in the maintenance of system identification for staggered credential renewals
  • Works with other staff to streamline and improve processes related to credentialing and provider data
  • Other job duties and projects as assigned

Qualifications:

  • Ability to critically analyze and apply standards to information submitted by the providers
  • Ability to communicate effectively with providers, including sensitive and confidential information
  • Must be able to prioritize and meet deadlines on an ongoing basis to ensure timely completion according to process requirements
  • Detail oriented and highly accurate
  • Demonstrates strong work ethic and maintains high expectation of individual work product
  • Medical Terminology
  • Proficiency in software applications to include data base integrity; and use of menu driven word processing and spreadsheet applications
  • Experience with credentialing software is preferred, but not required

How to Apply:

If interested in applying, please email your cover letter and resume through the form below or email to reception@proliancesurgeons.com.

About Proliance Surgeons:

Proliance Surgeons is one of the largest surgical practices in the country, with over 425 providers including over 250 board-certified physicians providing treatment at more than 100 care centers in Washington State. Our range of specialties includes orthopedics, sports medicine, spine, ear nose & throat, general surgery, ophthalmology, obstetrics & gynecology, urology and more. Many of our surgeries are performed at our own outpatient surgery centers—where costs are often lower and recovery times faster than at a hospital. Patients return home the day of their surgery to begin healing and rehabilitation and get back to doing what they love, faster. Proliance physicians helped more than 650,000 patients last year alone and performed over 85,000 surgeries. Please review our website for more information www.proliancesurgeons.com for more information about our practice.



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