This job was posted by https://idahoworks.gov : For more information,please see: https://idahoworks.gov/jobs/2155803 Credentialing Specialist

　　Remote from WA, OR, UT, or ID

　　Job Purpose

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

　　General Functions and Outcomes

　　This position has no reporting subordinates but will give directionto other employees (such as temporary employees and/oradministrative assistants) who are assigned to assist withcredentialing tasks.Manages and coordinates the credentialing/re-credentialing processfor Providers seeking participation or continued participation,which includes primary source verification which includes but is notlimited to the National Practitioner Data Bank, state licensingdepartments, malpractice insurers, educational institutions, boardcertifications and OIG sanctions list.Assists in the development and revision of Regence\'s credentialingpolicies and procedures. Ensures Regence\'s policies and proceduresmeet or exceed National Committee for Quality Assurance (NCQA)guidelines on an ongoing basis.Participates as an integral part of the Regence CredentialingCommittee\'s regarding policies and procedures and any informationpertaining to credentialing. Presents professional providerprofiles, with outstanding issues or problems, to the RegenceCredentialing Committee.Initiates and coordinates special issue projects to includeidentification and definition of problem, research and preparationof recommendations. Coordination of resolution and monitoring ofimplementation are included.Responsible for ensuring the Regence credentialing criteria isuniformly applied to all credentialed providers.Responsible for the validity and integrity of the provider data, byassuring the validity of provider credentials.Responsible for the evaluation of credentialing and re-credentialingfiles. Accurately analyzes the provider application/profile toassure that all Regence requirements have been satisfied. Identifiesany additional information needed, performs all necessary follow-up,and investigates any missing, incomplete, or unclear information inpreparation for formal presentation to the Credentialing Committee.Minimum Requirement

　　An undergraduate degree in an analytical field with at least fouryears of project-related work experience in the health care industryor equivalent combination of education and experience will beconsidered.At least three years of credentialing experience, or other relatedwork.Extensive knowledge of the local health care provider community,current state and federal legislation and credentialing andcontracting protocol, including primary source verification and NCQA(National Committee on Quality Assurance) requirements.Leadership skills and ability to work with people at all levelsthroughout the Company.Mature and professional demeanor evident in both written and phonecorrespondence; must have exceptionally strong oral and writtencommunication skills.Demonstrated project management skills, including ability to createand implement an action plan, coordinate tasks amongst variousdepartments and/or outside entities, and utilize available resourcesprudently.Ability to work independently as well as to initiate andsuccessfully conclude projects with no supervision.Experienced in presentation preparation and speaking to professionalcommittees.Knowledge and understanding of provider contracting requirements asthey relate to credentialing requirements.Normally to be proficient in the competencies listed above:

　　The Credentialing *Specialist II* would have an undergraduatedegree in an analytical field with at least four years ofproject-related work experience in the health care industry orequivalent 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 degreein an analytical field with seven years of project-related workexperience in the health care industry or the equivalent combination ofeducation 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 issupplemented with an exceptional 401(k) match, bonus opportunity andother benefits. In keeping with our Cause and vision, we offercomprehensive well-being programs and benefits, which we periodicallyupdate to stay current. Some highlights:

　　medical,