Title: Credentialing Specialist

Location: Administrative Office - Finance Department

City: Bellingham, WA

Position: Full-time, Monday-Friday, 8:00am-4:30pmnon-exempt (hourly)

Compensation: The full wage scale is $22.50 - $31.51 per hour. Placement within the wage range is determined by the candidate’s relevant experience.

Bonus: Employees are eligible annually to participate in discretionary bonus programs, as determined by FCN, which include the Years-of-Service bonus program, the Quality Performance bonus program, and the Performance Recognition bonus program.

Job Summary: The Credentialing Specialist position is responsible for successfully completing initial and subsequent credentialing packages as required by hospitals, and insurance carriers, including commercial payers, Medicare, and Medicaid.

We are looking for a qualified, motivated individual with a passion for family medicine who can:

• Coordinate all communications, submissions, activities and reporting for physicians, advance practice providers and behavioral health care managers initial credentialing, re-credentialing and licensure and certification requirements in a timely manner.
• Process applications, verify information and assure process is in accordance with medical staff bylaws.
• Be a resource for managers for planned start dates or new providers and sites.
• Maintain Credentialing databases (i.e., CAQH).
• Enters, updates and maintains data from provider applications into credentialing database, focusing on accuracy and interpreting or adapting data to conform to defined data field uses, and in accordance with internal policies and procedures.
• Proactively ensures compliance with each insurance carrier as to their specific insurance credentialing requirements (processes, forms, timelines, etc.).
• Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate.
• Communicates clearly with providers, their liaisons, entity Medical Staff Affairs, leadership, and Administration, as needed to provide timely responses upon request on day-to-day credentialing issues as they arise.
• Ensures proactive and timely approval of insurance credentials to allow for immediate and compliant billing.
• Prepares issues, electronically tracks and follows-up on appropriate verifications for efficient processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.
• Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state and local regulations, guidelines, policies, and standards.
• Conducts primary source verification, collects and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relative to credentialing standards.
• Assists providers to ensure timely attestations of the data service administrator accounts; alerts providers and management of any requirements that have not been met.
• Manages real-time reporting and updates to managers and clinics.
• Identifies and recommends improvements to workflows and processes to improve accuracy and efficiency.
• Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry.
• Safeguards confidentiality and ensure provider documentation and demographics are current.
• Other duties as assigned

Knowledge, Skills and Abilities:

• Excellent written and oral communication skills with all levels of management and staff.
• Proven ability to develop working relationships throughout the organization.
• High level of interpersonal skills to handle sensitive and confidential situations and documentation.
• Ability to use independent judgment and to manage and impart confidential information.
• Demonstrated ability to take initiative and effectively manage changing priorities.
• Detail-oriented with excellent follow through skills.
• Ability to respond to emails timely and effectively.
• Effective organizational, time management, and project management skills.
• Proficient in working with MS Office, specifically Excel and Word.
• Advanced skills in computerized spreadsheeting and database management.
• Knowledge of medical provider credentialing and accreditation principles, policies, processes, procedures, and documentation.
• Working knowledge of clinical operations and procedures.
• Skill in establishing priorities with independent coordination of day-to-day aspects.

About FCN: As an independent, locally owned, physician-run network of family medicine providers, we are passionate about our community's well-being. We take the time to build strong, long-term relationships with our patients and our employees. We have 12 clinics and 3 urgent care centers in Whatcom and Skagit County, in a beautiful corner of northwest Washington where the mountains meet the sea.

Benefits:

Our health benefit programs are designed to take care of you and your family, offering flexibility and quality care.

• Our health benefits include: two medical plan options, a flexible dental benefit including orthodontia, vision coverage, Employee Assistance Plans, Flexible Spending Account program and Life/AD&D, Hospital and Accident insurance plans. Benefit eligibility is determined based on the full or part-time status of the position.

At FCN, we value the importance of time away from work for leisure, health and well-being. Staff members accrue a generous Paid Time Off (PTO) program for vacation and short-term healthcare needs as well as an Extended Illness Bank (EIB).

• Our PTO and EIB benefits begin accruing from the first day of employment and employees are eligible to take paid time off after 60 days of employment. An employee accrues PTO at a rate based upon the number of months of service at FCN. A new full-time employee generally accrues 18 days per year. EIB accrues based upon the number of paid hours excluding overtime, with a full-time employee accruing a maximum of 48 hours per year. Benefit eligibility is determined based on the full or part-time status of the position. Employees who are ineligible for FCN’s PTO/EIB programs accrue Paid Sick Leave per Washington State law.

Our 401k retirement plan is designed to support you in preparing for retirement planning and includes individualized financial planning guidance. Eligibility for the FCN Retirement Plan programs is determined based upon years of service and required payroll hours.

We offer the following programs:

• 401k Plan with employer match; and
• 401k Profit Sharing Plan

Required Education and Experience:

• High School Diploma or equivalent
• 3 or more years of administrative experience, or equivalent knowledge and skills obtained through a combination of education, training and experience.
• Credentialing experience highly preferred
• Healthcare industry experience highly preferred

Physical Requirements: Performing the duties of this job requires ability to stand, walk, sit, climb stairs, use hand to finger coordination, handle or feel objects, tools or controls, reach with hands and arms, balance, stoop, kneel, crouch, talk or hear. The employee must occasionally lift and/or move up to 30 pounds. Specific vision abilities include: close vision, peripheral vision, depth perception and the ability to adjust and focus.

Immunization Requirements:

All employees at Family Care Network (FCN) are expected to meet and maintain required immunizations as a contingency of employment. The immunization requirements are as follows: Influenza (annually), Tdap (after the age of 19), MMR, Varicella or a verified history of chicken pox disease, Two-step TST or IGRA (within the last 12 months), COVID-19 vaccine completed series and any additional immunizations determined necessary for the protection of staff and patients. Hepatitis B is also required for employees in positions with a high risk of blood borne pathogen exposure, which includes the following: Providers, RN’s, LPN’s, MA-C’s, PSR’s at all Urgent Care Locations, and all-laboratory staff. The Hepatitis B vaccine is strongly recommended for all other employees. FCN will cover the cost of required immunizations for any FCN employee. All employee immunizations will be administered by FCN staff except for the COVID-19 vaccine. The COVID-19 vaccine can be administered at a participating pharmacy or other healthcare location. Note: A medical or religious vaccine exemption/reasonable accommodation will be considered by submitting a FCN Exemption form for review and evaluation by the Chief Medical Officer.

Family Care Network is a Drug-Free, Equal Opportunity Employer.