Position Summary: The Credentialing Specialist plays a dual role in ensuring that healthcare staff are both properly credentialed and compliant with licensing requirements, as well as overseeing the health and wellness of employees. This position is responsible for managing the credentialing process, maintaining compliance with regulatory standards, and providing health services, screenings, and education to employees to promote a healthy work environment.
Key Responsibilities of Nurse Credentialer:
Credentialing Management
Oversee the credentialing process for all healthcare Clinicians, ensuring that all licenses, certifications, and other required documents are up to date and compliant with state and federal regulations.
Verify and validate the credentials of new hires, including education, training, experience, and licensure.
Maintain a comprehensive and organized database of all credentialing information, ensuring timely renewals and updates.
Compliance and Auditing:
Ensure compliance with all relevant accreditation standards, including those set by The Joint Commission, CMS, and other regulatory bodies.
Prepare for and participate in audits, providing necessary documentation and responding to inquiries from Internal and External auditors.
Develop and implement policies and procedures related to credentialing and privileging processes.
Collaboration and Communication:
Work closely with the Human Resources department, department heads, and legal teams to address any credentialing issues or concerns.
Communicate effectively with healthcare providers to obtain required documentation and address any discrepancies.
Skills and Competencies:
Strong knowledge of credentialing processes, healthcare regulations, and compliance standards.
Excellent organizational skills with attention to detail.
Strong interpersonal and communication skills, with the ability to interact effectively with healthcare professionals and executives at all levels.
Ability to manage multiple priorities and work efficiently in a fast-paced environment
Minimum Mandatory Qualifications
Minimum of 2 years of experience directly related to hospital medical staff or managed care credentialing
Minimum of a high school diploma or GED require
Knowledge, Skills, Abilities and Other Qualifications
Proficient use of Microsoft Office (Word, Excel, and PowerPoint) and DocuSig
Demonstrated ability to communicate verbally and in writing throughout all levels of the organization, both internally and externally.
Strong communication skills
Ability to work well as a cooperative and supporting member of the team.
Ability to concentrate and pay close attention to details
Knowledge of, and sensitivity to, cultural and language differences
Excellent interpersonal skills in handling interactions with operational staff, providers, other agencies, groups, and team members.
Must be able to work as a team member and develop productive and cooperative working relationships with all members of the health care team.
A record of satisfactory performance in all prior and current employment as evidenced by positive employment references
Ability to perform other duties as assigned.
Work Environment
Physical demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the primary functions of this job. While performing the duties of this job, the employee may be required to frequently stand, walk, sit, bend, twist, talk, hear and perform repetitive motions. There may be prolonged periods of sitting, keyboarding, reading, as well as driving or riding in transport vehicles. Specific vision abilities required by this job include reading, distance, computer, and color vision. Talking and hearing are essential to communicate with clients, vendors and staff. Overnight travel may be required from time to time.
Mental demands:
There are a number of deadlines associated with this position. The employee must be able to handle frequent interruptions and must also multi-task and interact with a wide variety of people on various and, at times, complicated issues.
Confidentiality:
All employees must uphold all principles of confidentiality and patient care to the fullest extent. This position has access to sensitive information and a breach of these principles will be grounds for immediate termination.
Background Investigation:
This position may be subject to a 101-630 background check in an effort to ensure compliance with public law 101-630 “Indian child protection and family violence prevention act.” Candidates for positions that require a 101-630 background check must be able to successfully pass a background and character investigation in compliance with pl 101-630.
Performance Expectations
In performance of their respective tasks and duties all direct or leased employees of Tribal Health, LLC are expected to conform to the following:
Uphold all principles of confidentiality to the fullest extent.
Adhere to all professional and ethical behavior standards of the healthcare industry.
Interact in an honest, trustworthy and respectful manner with patients, employees, visitors and vendors.
Participate in departmental staff meetings, quality management activities and educational programs.
Comply with Tribal Health, LLC policies and procedures.
Display respect and understanding for all those they interact with.
Disclaimer: The information in this position description has been designed to indicate the general nature and level of work performance by employees in this position. It is not designed to contain, or be interpreted as, a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position. Employees will be asked to perform other duties as needed.
Native American Preference: Preference in filling vacancies is given to qualified Native American candidates in accordance with federal law (Title 25, USC Section 472). Form BIA-4432 should be submitted with the application. For more information about Native American Preference in employment please click here.
Equal Opportunity Employer: Tribal Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. We value the skills, experience, and dedication that veterans bring to the workplace and qualified veterans are encouraged to apply. Tribal Health is also committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans in our job application procedures. If you need assistance or an accommodation due to a disability, please let us know during the application process.
