Credentialing Specialist

Job Details:

Job Location:

2960 TONGASS AVE - KETCHIKAN, AK 99901, Position Type:
Regular Full-Time, Salary Range: $25.50 - $38.25 Hourly, Travel Percentage:
Negligible, Job Shift: M-F 8am-5pm, Job Category:
Clinic Administration, 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.

• 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.

• 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.

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…