COOK INLET TRIBAL COUNCIL, INC. 

JOB DESCRIPTION 

 

Job Title:             Credentialing Specialist 

Department:       Human Resources 

Reports To:         Sr. HR & Credentialing Supervisor 

Supervises:        None 

FLSA Status:      Non-Exempt 

Pay Grade:         N6  

Job Type:           Regular, Full-Time 

AKBCU: No        ICPA: No 

 

General Functions: 

The Credentialing Specialist plays a key role in supporting the behavioral health credentialing process under the direction of the Human Resources department. This position requires a high level of organization, accuracy, and attention to detail to effectively manage all aspects of credentialing behavioral health providers. The Credentialing Specialist is responsible for verifying that all providers are appropriately credentialed, licensed, and privileged in compliance with applicable local, state, and federal regulations, ensuring they are authorized to deliver services within the organization. 

 

Job Responsibilities:  

• Coordinate the credentialing and recredentialing of behavioral health providers, including physicians, psychologists, clinicians, counselors, case managers, and other clinical staff. 

• Verify provider credentials through primary source verifications (education, licensure, board certifications and other credentials). 

• Maintain current and accurate credentialing files in accordance with federal, state, and organizational guidelines. 

• Maintain an up-to-date provider database, monitoring and tracking certificate and license expiration dates, required renewals and continuing education compliance. 

• Audit and monitor credentialing files on an ongoing basis to confirm that all documentation is current, accurate, and aligned with internal policies and external regulatory requirements. 

• Work closely with internal departments and external agencies to gather information and resolve credentialing issues. 

• Respond to inquiries from internal staff, providers, and regulatory agencies regarding credential status. 

• Under the leadership of the Sr. HR & Credentialing Supervisor, ensure credentialing processes are being accurately conducted and communicated to staff. 

• Identify process improvements and contribute to the development of credentialing policies and procedures. 

• Maintain confidentiality according to regulations, policies, and procedures. 

• Other duties as needed and assigned.  

 

Job Specifications: 

• Excellent verbal and written communication skills. 

• Excellent public contact skills and telephone etiquette. 

• High level of accuracy and attention to detail. 

• Flexible and adaptable to shifting priorities and needs. 

• Strong problem-solving and critical thinking skills. 

• Strong time management skills with the ability to handle multiple deadlines and tasks efficiently. 

• Ability to work independently and with minimal supervision as well as collaboratively as part of a team.  

• Proficient with computers: word processing, email communication, internet resourcing, spreadsheets, and applicant tracking systems. 

• Knowledge of the Medicaid billing process. 

• Knowledge of HIPAA law and regulations including privacy rules and standards; Alaska public records law and processes. 

• Demonstrated knowledge and understanding of the social, health, education, training and cultural needs of the Alaska Native and American Indian community. 

 

Minimum Core Competencies: CITC Values, Respectful Leadership, Professionalism, Emotional Intelligence, Problem Solving/Critical Thinking, Communication Skills. 

 

Minimum Qualifications: 

• Associate degree in Human Resources, Business Administration, Accounting, Organizational Development, or related field. Relevant experience may substitute for the educational requirement on a year-for-year basis.  

• Two (2) years of experience in credentialing in a behavioral health or healthcare setting. 

• Two (2) years of experience compiling data, generating reports, and auditing information.   

• Knowledge of credentialing software and databases. 

• Continued employment is contingent upon completion of a satisfactory state and federal fingerprint criminal background check.  

 

Preferred Qualifications: 

• Bachelor’s degree in healthcare administration, Business Administration, Accounting, Human Resources, Organizational Development, or related field. Relevant experience may substitute for the educational requirement on a year-for-year basis. 

• Certification as Certified Provider Credentialing Specialist (CPCS) and/or Certified Professional Medical Services Management (CPMSM). 

 

Physical Requirements:  

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.   

• May require prolonged periods of sitting at a desk and consistently working on a computer with repetitive motion.   

• The need to occasionally move around the office to access filing cabinets, storage cabinets, and office equipment may be necessary.  

• Must be able to lift up to 25 pounds occasionally by utilizing proper lifting techniques and working in a safe manner.  

 

Disclaimer 

The information provided in this description has been designed to indicate the general nature and level of work performed by incumbents within this job. It is not designed to be interpreted as a comprehensive inventory of all duties, responsibilities, qualifications, and working conditions required of employees assigned to this job. Management has sole discretion to add or modify duties of the job and to designate other functions as essential at any time. This job description is not an employment agreement or contract.