POSITION TITLE: Credentialing and Contracting Specialist
DEPARTMENT: Health & Human Services (HHS) - Billing
LOCATION: Longview, WA
REPORTS TO: Medical Billing Supervisor
FLSA STATUS: Nonexempt, Full time
WAGE RANGE: $22.36 - $29.07

Closing Date: May 29, 2023

***If you are a Tribal Member and a Veteran and would like this status to have a preference in hiring, please list this on your cover letter and resume***

Position Summary:

Administers all aspects of contracting, credentialing, and privileging. Collects and verifies sensitive provider data through confidential sources. Maintains timely updates to information systems and regular reports used to monitor completion of applications. Assists with application completion and system coordination activity. Honors and represents the mission, vision, values of CIT and of the HHS department.

***If you are a Tribal Member and a Veteran and would like this status to have a preference in hiring, please list this on your cover letter and resume***

This list of duties and responsibilities is illustrative only of the tasks performed by this position and is not all-inclusive.

Essential Duties & Responsibilities:

• Conducts work within the guidelines of CMS, HCA, and AAAHC credentialing and privileging standards.
• Administers credentialing activities as related to initial credentialing, re-credentialing, and credentials modification.
• Ensures that the credentialing requirements for governmental agencies, commercial insurances, Medicare, Medicaid, and Managed Care insurers/networks are met and managed appropriately and timely.
• Submits and follow up on privileging and reappointments with Medical Staff Committee and Tribal Health Board
• Enters and maintains data in the contracting and credentialing databases according to established data entry rules and policies.
• Collects and verifies provider information through primary sources for initial enrollment and credentialing and for revalidation and renewal within established timeframes and in accordance with the standards required by accrediting/regulatory agencies.
• Maintains confidentiality of provider files and all information related to the credentialing and privileging process.
• Assesses, evaluates, and audits applications for completeness, accuracy, and essential criteria to meet required standards.
• Communicates adverse, incomplete, or questionable data to Director, Program Manager, or designee and recommends appropriate course of action.
• Participates in preparation for internal and external audits, and accreditation conducted for current and accurate provider information, policies and procedures, and compliance.
• Reviews contracts and works closely with legal department to ensure accuracy in agreement and all required obligations are met within contract as a tribal facility.
• Contributes to a team effort and accomplishes related results as required.
• Performs other duties as assigned.

Knowledge, Skills, and Abilities:

• Knowledge of traditional form of government and tribal customs and traditions.
• Knowledge of business English, proper spelling, grammar, punctuation, and basic arithmetic.
• Knowledge of basic medical terminology preferred.
• Knowledge of policies and procedures related to HIPPA, Medicare, Medicaid, and insurance programs.
• Knowledge of CMS, HCA, and AAAHC credentialing and privileging standards and provider and health plan credentialing.
• Knowledge of office functions, procedures, and policies.
• Skill in operating various word-processing, spreadsheet and database software programs in a Windows environment including electronic health care systems.
• Skill in treating internal and external customers with tact, courtesy, and respect.
• Skill in completing work with strict attention to detail.
• Ability to maintain confidentiality.
• Ability to interact and maintain good working relationships with individuals of varying social and cultural backgrounds.
• Ability to carry out instructions furnished in verbal or written format.
• Ability to communicate efficiently and effectively both verbally and in writing.
• Ability to handle multiple tasks, work independently, solve problems, and meet deadlines.
• Ability to exercise independent judgment.

Minimum Qualifications:

• High School Diploma/GED.
• One year credentialing experience.
• Valid driver’s license is required when driving vehicles for work-related purposes.
• Must be able to successfully pass a background screening / investigation according to the established requirements below.
• This position requires qualified applicants to be fully vaccinated including COVID-19 vaccines on the first day of employment.

Tribal preference in accordance with Cowlitz Indian Tribe Code and CIT Employee Policies and Procedures Handbook shall apply to all positions. All positions are required to adhere to CIT’s established safety policies regarding vaccine requirements and personal protective equipment (PPE).

Background Investigation Requirements:

• Pre-employment drug screen.
• Reference checks, education, and employment verification.
• Federal, state, and/or tribal criminal history and sanction checks.

Physical Demands:

While performing the duties of this job, the employee regularly is required to sit; use hands to finger, handle, or feel; and talk or hear. The employee occasionally is required to stand; walk; and reach with hands and arms. The employee is occasionally required to lift up to 20lbs. Specific vision abilities required by this job include close vision.

Work Environment:

Work is generally performed in an office/clinical setting with a moderate noise level. Situations occur where PPE (personal protective equipment) is needed. Tight time constraints and multiple demands are common.

The Cowlitz Indian Tribe is an Equal Opportunity Employer and a Drug & Alcohol-Free workplace.

Except as provided by Title 25 CFR, Section 472, which allows for Indian preference in hiring, the Cowlitz Indian Tribe does not discriminate based on race, color, creed, age, sex, national origin, physical handicap, marital status, politics, or membership or non-membership in an employee organization.