Credentialing Specialist

Company: Prairie Band Health Services

Position Title: Credentialing Specialist- Government Contracts

Job Classification: Full Time, Exempt

Work Schedule: M - F, 8a – 5p

Reporting Relationship: General Manager, PBHS

Location: Remote

Primary Accountabilities:

The Credentialing Specialist is responsible for coordinating and managing the credentialing, recredentialing, and privileging processes for healthcare providers supporting federal, state, tribal, and other government healthcare contracts. This position ensures compliance with contract requirements, regulatory standards, accreditation guidelines, and organizational policies. The Credentialing Specialist serves as the primary liaison between providers, contracting agencies, licensing boards, and internal departments to ensure providers are fully credentialed and eligible for assignment. This position plays a critical role in ensuring healthcare providers are fully qualified, compliant, and ready to support government healthcare programs and mission-critical patient care services.

Essential Duties and Responsibilities:

Provider Credentialing & Verification

• 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.

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).