Position Summary: Support department with general administrative office and credentialing functions. Familiarity with practitioner credentialing, recredentialing and enrollment with participating health plans, data entry, and customer service. Credentialing functions include, but are not limited to, verification of professional licensing, training, and certifications of professional medical staff, updating and maintaining database with the requirement that all employed healthcare professionals and services meet all applicable federal and state medical standards, The Joint Commission (TJC), Center for Medicare Services (CMS), as well as NCQA (National Committee for Quality Assurance) requirements by performing the following duties personally. Responsible for ensuring that all critical tasks are fulfilled on a timely basis.

Critical Tasks:

• Verifies individual medical certification, license and credential information to ensure current validity on a continuing basis.
• Confers with practitioners, and applicable health personnel to assure complete, accurate, and current medical credentials.
• Requests and receives pertinent documents from practitioners for initial credentialing, reappointment credentialing and privilege purposes.
• Assist Medical Staff Services team with responding to practitioner, client health plan and internal inquiries in a timely manner.
• Utilizes a variety of professional records indexes and storage/retrieval systems while maintaining perfect accuracy during all data entry activities.
• Performs sanction research and reporting.
• Operates computers to process, store, and retrieve medical credential information.
• Processes applications and reappointment paperwork, checking for full completeness and accuracy.
• Constantly collects and processes significant amounts of verification and accreditation information and must constantly maintain and update accurate databases for both practitioners and facilities. These databases include pertinent education, training, experience, and licensure content.
• Assist in process for enrollment applications and submit documents for signatures
• Assists and prepares records for auditing as needed.
• Performs all follow up necessary to ensure that all required data and information is received from practitioners on a timely basis while also ensuring that all credentialing deadlines are met.
• Maintains close communication with all medical practitioners to ensure that all records are up-to-date and consistentin the credentialing database and online systems; ensure timely renewal of licenses and certifications (i.e. State license, DEA certification, malpractice coverage and any other required credentialing documents for all practitioners to ensure compliance in a timely manner.)
• Ensures that all information sources for credential verification purposes are valid, accurate, and consistently respected.

Required Qualifications:

• High school graduation required
• College degree preferred.
• Minimum of 2 years of experience in a medical credentialing role
• CPCS certification by the National Association of Medical Staff Services preferred.
• Demonstrated ability to relate to diverse cultures and specifically the Gila River Community and/or other Native American cultures.
• Interest in medical subjects, patient services/care, and customer service.
• Prior medical environment work experience is preferred.