Credentialing Specialist
Prairie Band, LLC
- New York, New York, United States
- New York, New York, United States
Über
Coordinate the initial credentialing, recredentialing, and privileging of physicians, nurse practitioners, physician assistants, dentists, behavioral health professionals, nurses, and allied health providers.
Verify provider qualifications, including: State licensure, DEA registrations, Board certifications, Education and training, Work history, Professional references, Malpractice insurance, National Practitioner Data Bank (NPDB) queries, OIG and SAM exclusion checks
Maintain accurate and complete credentialing files in accordance with contract and regulatory requirements.
Monitor expiration dates and proactively obtain updated documentation before expiration.
Government Contract Compliance
Ensure compliance with requirements established by:
Indian Health Service (IHS)
Department of Defense (DoD)
Veterans Affairs (VA)
The Joint Commission
State licensing agencies
Review contract-specific credentialing requirements and ensure provider files meet all standards prior to deployment.
Assist with provider onboarding and clearance processes required for federal facilities.
Provider Onboarding & Support
Serve as the primary point of contact for providers during the credentialing process.
Communicate documentation requirements, deadlines, and status updates.
Coordinate onboarding activities with recruiting, human resources, compliance, and contract management teams.
Assist providers with applications, privileging packets, and government security clearance documentation as needed.
Auditing & Reporting
Conduct periodic audits of credentialing files to ensure accuracy and compliance.
Generate reports on credentialing status, upcoming expirations, and provider readiness.
Support internal and external audits by government agencies and accreditation organizations.
Maintain credentialing databases and tracking systems.
Process Improvement
Identify opportunities to improve credentialing workflows and turnaround times.
Develop and maintain credentialing policies, procedures, and standard operating practices.
Participate in quality assurance initiatives and compliance reviews. Requirements Required Qualifications:
High School diploma or GED required. Degree in business, or related field preferred . Minimum of 5 years of healthcare credentialing experience credentialing government healthcare contractors.
Must have experience with the government eApp and MD App.
Must have familiarity with government agencies such as Indian Health Service (IHS), VA, or DoD. Proficiency in Microsoft Office Suite (Excel, Word, Outlook, PowerPoint). • Strong understanding of credentialing regulations and industry standards.
• Familiarity with NPDB, PECOS, CAQH, OIG, SAM, and state licensing boards.
• Excellent organizational and time-management skills.
• Strong attention to detail and accuracy.
• Ability to manage multiple credentialing files and deadlines simultaneously.
• Excellent verbal and written communication skills.
• Proficiency with Microsoft Office Suite and credentialing management systems. Physical Demands:
Physically mobile with reasonable accommodation.
Ability to sit for extended periods of time.
Ability to read computer screens, email and talk on the phone.
Ability to bend, reach, kneel, twist and grip items while working at assigned desk area.
Work Environment:
Full Time Remote Additional Duties:
Additional duties and responsibilities may be added to this job description at any time. The job description does not state or imply that these are the only activities to be performed by the employee holding this position. Employees are required to follow any other job-related instructions and to perform any other job-related responsibilities as requested by their supervisor. Indian Preference Exercised:
Prairie Band, LLC is subject to Title 22: Employment Code of the Prairie Band Potawatomi Nation. In accordance with Title 22, this position is designated as a TIER 2 position. Preference will be given to individuals to the extent required pursuant to Section 22-2-4(B).
Sprachkenntnisse
- English
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