Credentialing Specialist

• Coordinate the credentialing and recredentialing of behavioral health providers, including physicians, psychologists, clinicians, counselors, case managers, and other clinical staff.
• Verify provider credentials through primary source verifications including education, licensure, board certifications, and other professional credentials.
• Maintain current and accurate credentialing files in accordance with federal, state, and organizational guidelines, ensuring complete documentation.
• Maintain an up-to-date provider database by monitoring and tracking certificate and license expiration dates, required renewals, and continuing education compliance.
• Audit and monitor credentialing files on an ongoing basis to confirm that all documentation is current, accurate, and aligned with internal policies and external regulatory requirements.
• Collaborate with internal departments and external agencies to gather information and resolve credentialing issues efficiently.
• Respond to inquiries from internal staff, providers, and regulatory agencies regarding credential status in a timely and professional manner.
• Support the Sr. HR & Credentialing Supervisor in ensuring credentialing processes are accurately conducted and communicated to staff.
• Identify process improvements and contribute to the development of credentialing policies and procedures to enhance efficiency.
• Maintain confidentiality according to regulations, policies, and procedures including HIPAA compliance.
• Perform all related duties as needed and assigned.

• Excellent verbal and written communication skills with professional telephone etiquette.
• High level of accuracy and exceptional attention to detail.
• Flexible and adaptable to shifting priorities and organizational needs.
• Strong problem-solving and critical thinking abilities.
• Strong time management skills with ability to handle multiple deadlines and tasks efficiently.
• Ability to work independently with minimal supervision while collaborating effectively as part of a team.
• Proficient with computers including word processing, email communication, internet research, spreadsheets, and applicant tracking systems.
• Knowledge of the Medicaid billing process and healthcare reimbursement systems.
• Knowledge of HIPAA law and regulations including privacy rules and standards, and Alaska public records law and processes.
• Demonstrated knowledge and understanding of the social, health, educational, training, and cultural needs of the Alaska Native and American Indian community.

• Continued employment is contingent upon completion of satisfactory state and federal fingerprint criminal background check.
• Associate degree in Human Resources, Business Administration, Accounting, Organizational Development, or related field. Relevant experience may substitute for the education requirement on a year-for-year basis.
• Two (2) years of experience in credentialing in a behavioral health or healthcare setting.
• Two (2) years of experience compiling data, generating reports, and auditing information.
• Knowledge of credentialing software and databases.

• Bachelor's degree in Healthcare Administration, Business Administration, Accounting, Human Resources, Organizational Development, or related field.
• Certification as Certified Provider Credentialing Specialist (CPCS) and/or Certified Professional Medical Services Management (CPMSM).

• May require prolonged periods of sitting at a desk and consistently working on a computer with repetitive motion.
• The need to occasionally move around the office to access filing cabinets, storage cabinets, and office equipment may be necessary.
• Must be able to lift up to 25 pounds occasionally by utilizing proper lifting techniques and working in a safe manner.

Cook Inlet Tribal Council