| Requirements |
Position: Credentialing Specialist Position Type: Full-time Exempt
Location: Hybrid (Remote + Frankfort, KY)
About KPCA:
The Kentucky Primary Care Association was founded in 1976 as a not-for-profit 501(c)(3) corporation of community health centers, rural health clinics, primary care centers, and all other organizations and individuals concerned about access to health care services for the state’s underserved rural and urban populations.
KPCA is charged with promoting the mutual interests of our members, with a mission to promote access to comprehensive, community-oriented primary health care services for the underserved.
Association members are providers of primary care – first contact, broadly trained physicians, physician assistants, nurse practitioners, behavioral health providers, dental providers, pharmacists, and other professionals delivering whole-person health care.
We support the development of primary care services throughout the Commonwealth by working with federal, state, and local legislators, regulatory agencies, health policy organizations, foundations, and payers to build a stronger primary care system in Kentucky.
About Role:
As the Credentialing Specialist, you will report to the Credentialing Manager, this position is responsible for creating and maintaining all credentialing files while ensuring adherence to NCQA credentialing standards. Strict adherence to following internal credentialing policies and procedures is vital when performing essential duties and responsibilities. The Credentialing Specialist will provide insights and support to all KPCA members, employees, and stakeholders.
The KPCA will employ the Credentialing Specialist as an at-will employee.
Essential duties and responsibilities include, but are not limited to:
- Understand the entire credentialing life cycle process.
- Create and maintain provider files; to include licensing, credentials, and insurance records.
- Monitor license and credentialing dates and advise members of requirement dates accordingly.
- Collect provider data and articulate/provide data analysis to internal stakeholders.
- Ability to comprehend data and discuss reporting to health plans and providers.
- Communicate and provide health plan specific reporting to individual health plans.
- Assure health care professionals are providing care that meets NCQA credentialing standards.
- Participates in continuous quality improvement monitoring and activities.
Key Competencies:
- Detail-oriented and focused on quality.
- Ability to meet strict deadlines.
- Analysis and problem solving.
- Work independently as well as within team with various backgrounds.
- Excellent communication and presentation skills.
- Understanding of NCQA credentialing standards.
- Ability to train employees to use software and hardware.
- Proficiency with data management tools.
- Project management.
- Ability to interpret and apply standard policies to highly variable situations.
- Familiarity with DMS.
- Familiarity with MCOs.
- Understanding of privacy and security re: PHI, HIPPA, HITECH and/or HITRUST.
- Qualifications:
- 2+ years of proven credentialing experience preferred.
- SQL (Sequel) experience preferred.
- Bachelor’s degree (or equivalent) in related field (preferred).
- Stand, walk, twist, bend, sit, enter data into a computer.
- Flexibility to work 40+ hours weekly, available to work Monday-Saturday as required.
Our Values:
- We are better together. (Emphasize collective good, impact of stakeholder group, avoid being more intrusive than helpful).
- Be curious. (Ask questions, dig deeper, be innovative, think like an entrepreneur, be a doer, solve problems).
- People first. (Nobody cares what you know until they know that you care).
- Heal the healer. (Support the care providers through TA, appreciation, value, workforce, community centers).
- Inclusive excellence. (DEI-J, invite more to table, develop together, distinctions with a difference, break down silos, cross germinate).
- Measure and learn. (Look at data, self-reflect, learn from history, informed strategy, it’s okay to fail and adapt, avoid rinse, and repeat unless proven).
Compensation and Benefits:
- Competitive salary.
- Full medical, dental, and vision insurance.
- 401(k) match.
- People-oriented culture.
This job description may not include all duties and responsibilities, the scope of which always remains subject to the direction of the KPCA and its Board of Directors. KPCA recognizes and appreciates the rich array of talents and perspectives that equal employment and diversity can offer our organization. KPCA is committed to making all employment decisions in accordance with federal, state, and local laws. No applicant shall be discriminated against in any terms, conditions or privileges of employment or otherwise be discriminated against because of the individual's race, creed, color, religion, gender, national origin or ancestry, age, mental or physical disability, sexual orientation, gender identity, genetic information, or veteran status. KPCA does not discriminate against any "qualified applicant with a disability" as defined under the Americans with Disabilities Act and will make reasonable accommodations when they do not impose an undue hardship on the organization.
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