Credentialing Specialist

Job Description

Job Description

Company Description

At NATIVE HEALTH, we strive to provide the best health care available for urban American Indians, Alaska Natives, and other individuals who generally experience barriers to health and wellness services.

Mission : To provide accessible holistic patient centered care, to empower our community to achieve the highest quality health and well-being.

Vision : Healthy People in Healthy Communities.

NATIVE HEALTH Benefits and Perks Include :

• Medical, Vision, and Dental Insurance
• Retirement Benefits - Up to 5% Matching Contribution
• Paid Time Off / Sick Leave
• Paid Holidays (12)
• Tuition Reimbursement and Educational Leave
• Employee Recognition Program
• Employee Wellness Program / Gympass Subscription

Starting Annual Salary : $59,987

Job Description

The Credentialing Specialist is responsible for all aspects of the initial credentialing, re-credentialing, and privileging processes for all licensed / certified providers and staff who provide patient care at Native Health.

This position maintains up-to-date data for each provider in credentialing databases and online systems and ensures timely renewal of licenses and certifications.

In addition, this position performs a variety of administrative support functions and activities for the Administrative Department.

KEY ACCOUNTABILITIES :

• Manages the initial credentialing and privileging process for all licensed or certified health practitioners including other clinical staff, contractors, volunteers, and students.
• Manages the re-credentialing and re-appointment of privileges process for all licensed or certified health practitioners including staff, contractors, volunteers, and students.
• Maintains complete files related to credentialing and health plan contracting ensuring privacy and confidentiality are safeguarded.
• Tracks credentialing and health plan contract data and completes follow up as deemed necessary.
• Maintains Employee Health Records
• Assists in ensuring the organization remains in good standing and meets all reaccreditation requirements.
• Supports the organization as needed.

Qualifications

QUALIFICATIONS / EXPERIENCE / REQUIREMENT :

• Associate or bachelor’s degree required.
• Certification / Licensure : Certified Provider Credentialing Specialist (CPCS) preferred.
• Two years of relevant credentialing experience preferred.
• Possess valid and unrestricted Arizona driver’s license (within 30 days of hire if applicant is from out-of-state) with no DUI / DWI or reckless driving convictions in the last five years.

No more than two at-fault accidents in the last three years. Must maintain a valid AZ driver license during employment. Must be insurable by NATIVE HEALTH liability auto policy.

• Must pass a criminal background check with a Class I Fingerprint Clearance Card within the initial ninety (90) calendar days of employment.
• Must pass a substance abuse testing upon employment and submit to a random testing during employment.
• Must have a current (within 12 months) Tuberculosis (TB) skin report upon employment and provide an update annually.
• Must be up to date on immunizations.
• Must obtain a CPR Card within ninety (90) calendar days of employment and maintain a valid CPR card during employment.

KNOWLEDGE, SKILLS AND ABILITIES :

• Proficient knowledge of the credentialing and privileging process.
• Knowledge of health plan credentialing processes for FQHC and individual providers.
• Must be dependable, punctual, and reliable.
• Strong organizational skills that reflect ability to perform and prioritize multiple tasks seamlessly with excellent attention to detail.
• Excellent verbal and written communication skills including, letters, memos and emails.
• Ability to read and comprehend material with moderate to high level of difficulty.
• Ability to write correspondence in a professional manner.
• Excellent attention to detail.
• Ability to research and analyze data.
• Ability to work independently with minimal supervision.
• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
• Proactive approaches to problem solving with effective and efficient decision-making capability.
• Emotional maturity.
• Highly resourceful team player, with the ability to be effective independently.
• Proven ability to handle confidential information with discretion, be adaptable to various competing demands, and demonstrate the highest level of customer / client service and response.
• Culturally competent and able to work with a diverse workforce and population.
• Proficient use of Microsoft Office applications (Word, Excel, Access, Outlook) and internet resources.

Additional Information

NATIVE HEALTH. is an EEOC, Employment-At-Will, and Native American Preference employer. Drug Free and Commercial Smoke-Free work environment.