Healthcare Credentialing & Enrollment Specialist

Rocky Boy Health Center; Box Elder (MT); On-site; USD 52,000 - 65,000; Full time

Job summary

Rocky Boy Health Center is seeking a Credentialing Specialist to coordinate provider credentialing, privileging, and recredentialing, ensuring compliance with medical bylaws, accreditation standards, payer requirements, and tribal regulations.

You will support background investigations, maintain credentialing databases, monitor licensure, and assist with enrollment and revalidation activities to onboard providers and ensure billing readiness.

Qualifications

• Associate's degree in Healthcare Administration, Business Administration, Health Information Management, Human Resources, or a related field; or an equivalent combination of education and experience.
• Two (2) years of experience in healthcare credentialing, medical staff services, regulatory compliance, human resources, provider enrollment support, or a related administrative healthcare role.
• Strong organizational skills with the ability to manage multiple priorities and meet deadlines.
• Proficiency with Microsoft Office and electronic database systems.
• Ability to maintain strict confidentiality and exercise sound judgment when handling sensitive information.
• Excellent written and verbal communication skills.

Responsibilities

• Coordinates the initial appointment, reappointment, recredentialing, and privileging processes for physicians, advanced practice providers, dentists, pharmacists, and other licensed independent practitioners.
• Performs primary source verification of education, licensure, certifications, training, work history, malpractice coverage, and other credentialing requirements.
• Processes credentialing applications in accordance with Medical Staff Bylaws, organizational policies, and accreditation standards.
• Queries the National Practitioner Data Bank (NPDB), Office of Inspector General (OIG), System for Award Management (SAM), and other required exclusion or sanction databases.
• Maintains confidential credentialing files and electronic credentialing databases.
• Monitors provider licenses, certifications, DEA registrations, and other required credentials to ensure timely renewal and continued compliance.
• Assists with preparation for accreditation surveys and regulatory reviews.
• Assists the Revenue Cycle Manager with provider enrollment, revalidation, and maintenance for Medicare, Medicaid, commercial insurance plans, and other third-party payers.
• Maintains enrollment records and assists with payer requests for additional documentation.
• Monitors enrollment and revalidation deadlines and communicates upcoming requirements to appropriate staff.
• Assists with maintaining provider information in CAQH, PECOS, NPPES, and other enrollment systems as applicable.
• Coordinates and conducts comprehensive background investigations for employees, contractors, volunteers, students, and other individuals requiring organizational clearance.
• Verifies criminal history, education, employment history, professional references, licensure, certifications, identity, driving records, and other required screening elements.
• Maintains knowledge of applicable accreditation standards, credentialing requirements, and regulatory changes affecting provider credentialing and employment screening.
• Assists with policy development and updates related to credentialing and regulatory compliance.
• Prepares reports and maintains documentation required for audits, accreditation surveys, and regulatory inspections.
• Collaborates with Human Resources, Medical Staff, Revenue Cycle, Compliance, and other departments to support organizational objectives.
• Performs other duties as assigned.

Skills

Organizational skills

Communication skills

Confidentiality

Microsoft Office

Credentialing software

Education

Associate's degree in Healthcare Administration, Business Administration, Health Information Management, Human Resources, or related field

Bachelor's degree in Healthcare Administration, Business Administration, Health Information Management, Public Administration, or related field

Tools

CAQH

Job description

Rocky Boy Health Center is seeking a Credentialing Specialist to coordinate provider credentialing, privileging, and recredentialing, ensuring compliance with medical bylaws, accreditation standards, payer requirements, and tribal regulations.

You will support background investigations, maintain credentialing databases, monitor licensure, and assist with enrollment and revalidation activities to onboard providers and ensure billing readiness.