Credentialing Support Associate III at Guardian in Work From Home, WA

Job description

RESPONSIBILITIES: Enters and upkeeps provider data in the credentialing database. Facilitates recredentilaling malings to network providers according to process guidelines. Monitors and communicates with providers to address any discrepancies or missing information, including regular follow up outreach attempts. Performs primary source verification of provider applications submitted for initial credentialing and re-credentialing according to regulatory requirements and company standards. FAMILY: CREDENTIALING: Responsible for the credentialing and re-credentialing of applications for prospective and contracted vision, dental and hearing providers. Ensures all state and federal regulations are met, and that all activities are compliant with National Committee for Quality Assurance (NCQA) standards. Position Summary Are you detail-oriented and passionate about ensuring accuracy and compliance in healthcare provider data? Do you enjoy working in a fast-paced environment where organization, communication, and problem-solving are critical to success? Guardian is seeking a Credentialing Support Associate III to support the provider credentialing and recredentialing process by maintaining accurate provider records, coordinating provider outreach, and ensuring compliance with regulatory and organizational requirements. In this role, you will work closely with providers and internal stakeholders to validate information, resolve discrepancies, and support high-quality provider network operations. A highly organized professional with exceptional attention to detail and a commitment to accuracy. You thrive in structured processes, enjoy managing multiple priorities, and can effectively communicate with providers to obtain critical information and resolve issues. You understand the importance of compliance and take pride in maintaining accurate records while delivering excellent customer service. You Have Required Qualifications High school diploma or equivalent; Associate's or Bachelor's degree preferred Experience supporting provider credentialing, healthcare operations, provider enrollment, or administrative processes Experience maintaining and updating data within databases or business systems Strong attention to detail and commitment to data accuracy Excellent verbal and written communication skills Ability to follow established processes and regulatory requirements Strong organizational and time management skills Ability to manage multiple priorities in a deadline-driven environment Proficiency with Microsoft Office applications, including Excel and Outlook Preferred Qualifications Experience with provider credentialing and recredentialing processes Familiarity with NCQA, CMS, state, or other healthcare regulatory requirements Experience conducting primary source verification activities Experience working with credentialing software or provider management systems Knowledge of healthcare provider networks and credentialing standards You Will Maintain accurate provider information by entering, updating, and auditing data within credentialing systems. Coordinate recredentialing activities, including distributing recredentialing communications and monitoring provider responses. Communicate with providers to obtain missing documentation, resolve discrepancies, and ensure complete credentialing files. Conduct primary source verification activities for initial credentialing and recredentialing applications in accordance with regulatory requirements and company standards. Track and follow up on outstanding credentialing requirements to support timely processing and compliance. Partner with internal stakeholders to ensure provider records are accurate, complete, and compliant with organizational policies. Support continuous improvement efforts that enhance credentialing processes and data quality. Reporting Relationships As our Credentialing Support Associate III , you will report to the Credentialing leadership team. Location The primary loc