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.
