Credentialing Specialist

The Rural Health Enterprise (RHE) is a dynamic for-profit subsidiary of The Rural Collaborative, owned collectively by 25 rural hospitals across Washington State. We are dedicated to enhancing the sustainability and quality of rural healthcare.  RHE provides crucial support through interdependence and value-based services. We are currently seeking a motivated and experienced Credentialing Specialist to join our team.

Position Overview: The Credentialing Specialist at RHE plays a pivotal role in the day-to-day provider enrollment functions and CVO file processing. 

Responsibilities:

• Actively supports the Enterprise’s culture [Respect, Trust, Joy and Ownership] through thought and deed.


• Represents the Enterprise in a positive and professional manner.


• Processing and execution of the Program to assure continued delegation by Health Plans.


• Processing and execution of the CVO Program to assure continued delegation by rural hospitals.


• Understand and follow National Committee for Quality Assurance (NCQA) guidelines, applying the guidelines as needed.


• Understand and follow Enterprise’s Delegated Credentialing Policies & Procedures.


• Understand and follow requirements of the Enterprise’s Delegation Agreements with delegated Health Pans.


• Maintain systems to identify enrolled providers and prepare and maintain records as required.


• Complete credentialing verifications and file documentation for enrolling providers as required under the Delegation Agreements, and Health Plan policies. 


• Complete and maintain delegated roster using the most current Washington Standardized Delegated Roster. Adjust and modify roster as needed in accordance with Health Plan requirements. 


• Interface and coordinate with participating hospitals to ensure time receipt and accuracy of required credentialing and enrollment forms including but not limited to the Washington Practitioner Application (WPA).


• Prepare provider enrollment application files and prepare documentation for approval by Delegated Credentialing Committee.


• Process post file approval tasks including notification letters to hospitals and updates to systems.


• Process all provider demographic changes requested by facilities, with appropriate data trails, updating Enterprise systems and Washington Standardized Delegation Roster with new data. 


• Complete enrollment process within state law standards from receipt of completed application.


• Monitor systems for upcoming recredentialing and request and process updated application & required documents within at least four months of re-credentialing date.


• Monitor and revise credentialing and enrollment forms as needed.


• Ensure maintenance of enrolled provider files and ensure information is protected as needed.


• Understand, process and follow documentation requirements for monthly ongoing monitoring as dictated by the delegation agreement


• Communicate enrollment information to appropriate departments or personnel.


• Provides assistance to Manager for health plan monthly reporting as needed. Serves as back up in Manager’s absence.

Qualifications:

• High School Diploma or equivalent required


• Minimum of 2 years experience in healthcare credentialing required


• CPCS (Certified Provider Credentialing Specialist) certification strongly preferred


• Experience using MD Staff software also preferred


• Strong understanding of credentialing standards, regulations, and best practices


• Proficiency with Microsoft Office Suite with particular emphasis on Microsoft Excel


• High proficiency in use of internet and search engines for research and information gathering


• Typing speed of 50+ wpm


• Willing to be flexible and to modify work schedule, as needed within reason


• Excellent communication and organizational skills


• Ability to work independently and collaboratively in a remote work environment


• Must perform work from the state of Washington 


• Ability to travel for in-person meetings on occasion (less than 5%)

Why Join Us: RHE offers a dynamic work environment where you can make a significant impact on rural healthcare delivery in Washington State. As part of our team, you will have the opportunity to contribute to meaningful projects and initiatives that support our mission of enhancing rural hospital sustainability through collaborative, value-based services.

RHE offers competitive pay and benefits including M/D/V, HSA contribution, retirement match of 6%, and generous PTO. 

Join us at RHE and be part of a team that is dedicated to making a difference in rural healthcare!