Credentialing & Billing Specialist
The Credentialing & Billing Specialist coordinates provider credentialing, enrollment, and billing support activities across Kahtnuht’ana Development Corporation (KDC) operations, including all awarded proposals, Indian Health Service (IHS) contracts, and Tribal health systems. This role ensures providers are properly credentialed and enrolled with federal, state, Tribal, and commercial payers and supports accurate, compliant billing processes.
RESPONSIBILITIES
- Coordinate credentialing, recredentialing, privileging, and enrollment with Medicare, Medicaid, commercial payers, Tribal programs, and IHS.
- Maintain provider enrollment records and ensure timely submission of applications and renewals.
- Track expirations for licenses, certifications, Drug Enforcement Administration (DEA), malpractice coverage, and other required documentation.
- Communicate credentialing requirements and status updates to providers and leadership.
- Maintain accurate provider files and credentialing records.
- Support billing functions including claim review, charge entry, corrections, payment posting, and denial follow up.
- Resolve credential-related billing holds and reimbursement delays.
- Coordinate with Revenue Cycle, HR, Compliance, Medical Staff, and operational leadership.
- Ensure compliance with Health Insurance Portability and Accountability Act (HIPAA), Medicare, Medicaid, Tribal, and payer regulations. Ensure provider enrollment accuracy for Prospective Payment System (PPS), All Inclusive Rate (AIR), and wrap around reimbursement programs.
- Monitor payer effective dates, taxonomy codes, National Provider Identifier (NPI) updates, and Council for Affordable Quality Healthcare (CAQH) requirements.
- Coordinate credentialing and enrollment for Purchased/Referred Care (PRC) and Tribal health programs.
- Assist with maintaining charge master accuracy related to provider enrollment and billing privileges.
- Support onboarding workflows to ensure providers are credentialed and enrolled prior to service delivery under federal and Tribal contracts.
- Participate in audits, reporting, and process improvement initiatives.
- Support training related to credentialing and billing requirements.
- Travel up to 40%.