Credentialing Specialist at Great Plains Tribal Health

Job Summary

This position is responsible for the coordination of all administrative aspects of the credentialing/privileging program for the Oyáte Health Center (OHC), and for providing administrative support to the medical staff.

Essential Functions

• Credential Verification: Review and authenticate healthcare providers' credentials, qualifications, licenses, and certifications.
• Compliance Assessment: Ensure compliance with state, federal, and internal regulations and standards. Ensuring that licenses are valid, certifications are up-to-date, and professionals meet the necessary educational or training standards.
• Application Processing: Process initial credentialing and re-credentialing applications.
• Privilege Alignment: Ensure requested privileges match candidates' education, training, and certifications.
• Quarterly Reviews: Conduct quarterly reviews of credentialing and privileging for all licensed clinicians.
• Quality Reviews: Ensure integrity and compliance with credentialed clinician applications.
• Maintain accurate and current credentialing files.
• Communication: Maintain effective communication with healthcare providers and other stakeholders to secure necessary documentation. Address inquiries promptly, stay informed about credentialing requirements, and facilitate communication to resolve compliance issues.
• Monitoring Expirations: Monitor expiring credentials and facilitate timely renewals.
• Issue Resolution: Conduct investigations and resolve credentialing discrepancies.
• Reporting: Record minutes during Clinical Medical Committee meetings. Prepare and submit detailed reports on credentialing activities.
• Participate in internal and external credentialing audits.
• Database Management: Responsible for updating credentialing databases and software systems. This includes maintaining accurate and confidential information in credentialing software, updating details, tracking expiration dates of licenses or certifications, and ensuring data integrity.
• Reviews a sample of clinical staff and allied health professional applications for completeness and ensures requested reports from the National Practitioner Data Bank and the Healthcare Integrity Bank are done.
• Ensures that requested privileges align with the applicant’s education and training and are processed within the established time frames in coordination with the clinical executive committee.
• Provides comprehensive information packages to facilitate decision-making by the Chief Medical Officer and the clinical executive committee/governing body.
• Review clinical staff members' current privileges.
• Evaluate the privileging and credentialing process, including provider performance profiles.
• Must comply with federal laws and regulations as required by the Health Insurance Portability and Accountability Act (HIPAA).
• Performs related duties.
  
  

Requirements

• Participates in Core Connections training and applies GPTLHB Core Connections concepts and practices in their work.
• Familiarity and/or experience working with American Indian populations and respect for and knowledge of traditional, cultural, and spiritual practices of diverse American Indian communities, as well as an ability to work with other culturally and ethnically diverse populations.
• Proficiency with computer programs (Word, Excel, PowerPoint) and other Internet technologies.
• Valid driver’s license must be kept current, and certificates, credentials or licenses must be kept current and consistent with regulations required by applicable federal, state and/or grant regulations as applies to position.
• Work in a cooperative and professional manner with OHC and GPTLHB staff.
• Treat Great Plains tribes and collaborators with dignity and respect.
• Utilize effective verbal and written communication skills.
• Advance personal educational development by attending training sessions and seminars as appropriate.
• Exemplify excellent customer service with tribal stakeholders, health board colleagues, program partners, service recipients, visitors and guests.
• Foster a work environment of wellness, courtesy, friendliness, helpfulness and respect.
• Consistently demonstrate respect for and acceptance of differing capabilities, cultures, gender, age, sexual orientation and/or personalities.
• Maintain and ensure organizational privacy and confidentiality.
• Promote an alcohol, tobacco and drug-free lifestyle.
  
  

Minimum Education & Experience Requirements

Bachelor’s degree and three (3) years of progressively responsible relevant experience, or an associate’s degree and five (5) years of progressively responsible experience, or a high school diploma or GED and seven (7) years of progressively responsible experience. The experience required for supervisory positions will be inclusive of at least one (1) year of supervisory/management experience.

Certified Provider Credentialing Specialist (CPCS) certification through the National Association Medical Staff Services (NAMSS) is preferred.

Native American/American Indian Preference in hiring will be applied as defined in title 25 usc 44-46 &474.

Employment is contingent upon the outcome of all required criminal background checks and pre-employment drug screen.

Compliance with our Employee Health Procedure is a condition of employment. You are required to agree that you will comply with all job-related employee health screening and immunizations prior to your first day of employment. Jobs require that you have documentation that you have completed the following immunizations prior to your first day of employment: MMR (Measles, Mumps and Rubella, Varicella (Chicken Pox), Hepatitis B, Influenza, T-dap (Tetanus - Diphtheria - Pertussis), and COVID-19 vaccination is required .