• Job Description

  Req#: R-4639

  Credentialing Specialist

  Remote from WA, OR, UT, or ID

  Job Purpose

  Responsible for the management and coordination of the credentialing and re-credentialing processes based on Regence Credentialing Policies and other Regulatory requirements.

  General Functions and Outcomes

  • This position has no reporting subordinates but will give direction to other employees (such as temporary employees and/or administrative assistants) who are assigned to assist with credentialing tasks.

  • Manages and coordinates the credentialing/re-credentialing process for Providers seeking participation or continued participation, which includes primary source verification which includes but is not limited to the National Practitioner Data Bank, state licensing departments, malpractice insurers, educational institutions, board certifications and OIG sanctions list.

  • Assists in the development and revision of Regence’s credentialing policies and procedures. Ensures Regence’s policies and procedures meet or exceed National Committee for Quality Assurance (NCQA) guidelines on an ongoing basis.

  • Participates as an integral part of the Regence Credentialing Committee’s regarding policies and procedures and any information pertaining to credentialing. Presents professional provider profiles, with outstanding issues or problems, to the Regence Credentialing Committee.

  • Initiates and coordinates special issue projects to include identification and definition of problem, research and preparation of recommendations. Coordination of resolution and monitoring of implementation are included.

  • Responsible for ensuring the Regence credentialing criteria is uniformly applied to all credentialed providers.

  • Responsible for the validity and integrity of the provider data, by assuring the validity of provider credentials.

  • Responsible for the evaluation of credentialing and re-credentialing files. Accurately analyzes the provider application/profile to assure that all Regence requirements have been satisfied. Identifies any additional information needed, performs all necessary follow-up, and investigates any missing, incomplete, or unclear information in preparation for formal presentation to the Credentialing Committee.

  Minimum Requirement

  • An undergraduate degree in an analytical field with at least four years of project-related work experience in the health care industry or equivalent combination of education and experience will be considered.

  • At least three years of credentialing experience, or other related work.

  • Extensive knowledge of the local health care provider community, current state and federal legislation and credentialing and contracting protocol, including primary source verification and NCQA (National Committee on Quality Assurance) requirements.

  • Leadership skills and ability to work with people at all levels throughout the Company.

  • Mature and professional demeanor evident in both written and phone correspondence; must have exceptionally strong oral and written communication skills.

  • Demonstrated project management skills, including ability to create and implement an action plan, coordinate tasks amongst various departments and/or outside entities, and utilize available resources prudently.

  • Ability to work independently as well as to initiate and successfully conclude projects with no supervision.

  • Experienced in presentation preparation and speaking to professional committees.

  • Knowledge and understanding of provider contracting requirements as they relate to credentialing requirements.

  Normally to be proficient in the competencies listed above:

  The Credentialing Specialist II would have an undergraduate degree in an analytical field with at least four years of project-related work experience in the health care industry or equivalent combination of education and experience will be considered. At least three years of credentialing experience, or other related work.

  The Credentialing Specialist III would have an undergraduate degree in an analytical field with seven years of project-related work experience in the health care industry or the equivalent combination of education and experience.

  Work Environment

  Typical office environment (i.e. sitting at PC, etc.)

  The base pay range for a Credentialing Specialist II job is $23.00 - $37.50/hour, depending on candidate's geographic location.

  The base pay range for a Credentialing Specialist III job is $25.30 - $41.30/hour, depending on candidate's geographic location.

  The annual incentive payment target for this position is 5%

  Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:

  • medical, dental, and vision coverage for employees and their eligible family members

  • annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)

  • paid time off varying by role and tenure in addition to 10 company holidays

  • up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)

  • up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)

  • one-time furniture and equipment allowance for employees working from home

  • up to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.

  We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

  If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com . Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy . As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.

• About the company

  Cambia Health Solutions is a nonprofit health care company based in Portland, Oregon.

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