Credentialing Specialist

Job Summary: 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.

Job Duties & 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.

Necessary Knowledge, Skills, and Abilities: 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.

Working Conditions: The physical demands described here are representative of those that an employee must meet to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions. While performing the duties of this Job, the employee is regularly required to use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is frequently required to stand and/or sit. The employee is occasionally required to walk, sit, climb, or balance. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, peripheral vision, and depth perception. The noise level in the work environment is usually average.

KIC Competencies: Cultural Competency: To be respectful and responsive to the health beliefs, practices, and cultural and linguistic needs of KIC Tribal Members. Developing cultural competence is an evolving, dynamic process that takes time and occurs along a continuum. Uphold Values: To make decisions and behave in a manner consistent with KIC Workplace Values of Trust, Teamwork, Respect, and Accountability, as well as Southeast Traditional Tribal Values "Our Way of Life".Commitment: To serve Tribal Members and set a high standard for yourself in your performance; strive for results and success; convey a sense of urgency and bring issues to closure; and stay persistent despite obstacles and opposition. Customer Service: Meet/exceed the expectations and requirements of internal and external customers; identify, understand, and monitor the needs of both internal and external customers; always talk and act with customers in mind; and recognize working colleagues as customers. Effective Communication: Ensure important information is passed to those who need to know; convey necessary information with respect, clearly and effectively orally or in writing Responsiveness and Accountability: Demonstrate a high level of conscientiousness; hold oneself personally responsible for one's own work; and do the required fair share of work.