Credentialing Specialist

Ketchikan Indian Community • Ketchikan, AK

9d • $26 - $38 • Onsite

About The Position

The Credentialing Specialist is responsible for coordinating all aspects of the provider credentialing, recredentialing, and privileging processes to ensure practitioners meet organizational, regulatory, accreditation, and payer requirements. This position maintains accurate and complete credentialing records, verifies provider qualifications through primary source verifications, conducts continuous monitoring activities, and supports the organization’s commitment to providing safe, high-quality healthcare.

Requirements

• Strong understanding and sensitivity to American Indian/Alaska Native (AI/AN) Tribal culture and lifestyle, working effectively with AI/AN populations.
• Effective oral and written communication skills with sensitivity to the lifestyles of targeted participants.
• Skills in operating personal computers using a variety of computer software.
• Ability to establish and maintain cooperative working relationships with management, coworkers, and outside contacts.
• Ability to maintain strict confidentiality and comply with all applicable federal and tribal privacy laws and KIC policy (HIPAA, HITECH, etc.).
• Ability to learn and apply program/agency operating policies and procedures.
• Ability to manage multiple priorities and tasks concurrently and meet deadlines.
• Ability to work independently as well as with teams.
• High School Diploma or GED
• Minimum three years’ experience in administrative/secretarial supervisory experience and one year of project coordination or executive assisting required.
• Must obtain certification as Certified Professional Medical Services Management (CPMSM), Certified Medical Staff Coordinator (CMSC), and/or a Certified Provider of Credentialing Services (CPCS) within three (3) years of hire.
• Proof of valid driver's license with acceptable driving record (when DL is required for the job).

Nice To Haves

• Motivation for professional and career advancement preferred.
• A combination of relevant experience, education, and training may substitute for education and experience requirements on a year-for-year basis.
• Associates degree in healthcare, administration, project management or other related field.
• Certification as a Certified Professional Medical Services Management (CPMSM), Certified Medical Staff Coordinator (CMSC), and/or a Certified Provider of Credentialing Services (CPCS) is preferred but not required.

Responsibilities

• Coordinates the credentialing, reappointment, and privileging for all applicable licensed health care professionals.
• Performs primary source verification of education, training, licensure, board certification, DEA registration, work history, references, and other required credentials.
• Tracks expiration dates for licenses, certifications, DEA registrations, CPR certifications, malpractice insurance, and other required credentials to ensure timely renewal, while also ensuring providers are in good standing.
• Conducts continuous monitoring for sanctions and exclusions through required databases including OIG, SAM, NPDB, state licensing board, and other regulatory agencies.
• Coordinates Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE) documentation, as applicable.
• Ensures credentialing files are complete, accurate, and maintained according to organizational policy and accreditation standards.
• Prepares credentialing files for review by credentialing committees, governing body, or other designated leadership, while maintaining confidentiality of all credentialing records.
• Provides credentialing documentation and coordinates the completion of provider enrollment forms to support all payer enrollment activities.
• Cross-trains within other Quality functions to provide coverage when needed and support departmental operations.
• Other related duties as assigned.

Benefits

• KIC is a Drug-Free Workplace. All employees must adhere to KIC drug and alcohol policies and procedures to ensure a safe workplace. Employees must pass a pre-employment and subsequent random and/or for cause drug and alcohol screening to be eligible for and maintain employment.
• KIC has several positions that must comply with the P.L. 101-630 Indian Child Protection and Family Violence Protection Act (ICPA); all employment offers in the "covered" classification are conditional until KIC has received a federal criminal background check verifying eligibility to work in these programs.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED