Kaiser Permanente Specialist Credentialing in Renton, Washington
The Credentialing Specialist is responsible for all aspects of initial credentialing, recredentialing, and privileging. Collect and verify sensitive provider and practitioner data through confidential sources. Maintain timely updates to information systems and regular reports used to monitor completion of applications. Audit files based on internal standards and regulatory requirements. Assist other internal departments with application completion and system coordination activity. Work independently with very little supervision to meet specified timeframes. KP's culture of compliance requires all staff to integrate applicable laws, regulations, and contractual obligations as a part of their daily standard work to ensure that process results meet these obligations.
The Credentialing Specialist is responsible for all aspects of initial credentialing, recredentialing, and if applicable privileging of practitioners or providers within credentialing scope who are employed or contracted to provide care to Kaiser Foundation Health Plan of Washington members. Collect and verify provider and practitioner information through primary sources for initial appointment and for re-appointment within established time frames and in accordance with the standards required by accrediting/regulatory agencies (CMS, DSHS, NCQA & TJCor DNV). Maintain confidentiality of provider files and all information related to the credentialing process. Audit files based on KP and regulatory standards. Audit applications for completeness, accuracy and essential criteria to meet required standards.
Create and maintain credentialing database to keep data current and accurate. Run standard reports to monitor work and ensure completion of applications in a timely manner. Provide written and verbal communication with federal, state and local agencies, hospitals, medical review boards and malpractice carriers to obtain provider and practitioner information. Assess, evaluate and interpret application and verification information to identify 'red flags' or areas of established non-compliance. Communicate adverse, incomplete, or questionable data to Medical Director, Credentials Committee Chair, or designee and recommend appropriate course of action. Maintain strict confidentiality and apply professional discretion when areas of concern are identified. Participate in preparation for internal and external audits conducted for current and accurate provider information or delegation compliance. Coordinate Credentialing Committee meetings and agendas, including minutes and follow up action
Manage incoming and outgoing mail while meeting policy timelines and updating the credentialing database. Keep Track of pended information and follow up in an appropriate timeframe. Provide assistance with special projects. May scan working documents, make copies, assist with mass mailings, distribute faxes and/or help file correspondence and pertinent materials. Participate in research, review and interpretation of applicable accreditation, licensing, and other regulatory requirements to ensure credentialing policies and policies continually meet requirements. Participate in design and development of forms to support credentialing process.
Assist other internal departments, with application completion and systems coordination activity. Provide status reports and communicate practitioner participation information to internal and external customers. Maintain written and verbal communication with Credentialing Committee members and Board of Trustees.
Associate's degree OR two (2) years of experience in a directly related field.
High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- Certified Provider Credentialing Specialist (CPCS) is required or within 18 months of hire.
Experience in managed care, hospital or medical office environment.
Demonstrated ability to manage multiple priorities and competing deadlines.
Basic computer skills, with proven knowledge of database creation and maintenance and MS Word.
- Bachelor's degree with coursework in health care
TITLE: Specialist Credentialing
LOCATION: Renton, Washington
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.