Credentialing Specialist

Credentialing & Enrollment Specialist

Rural Psychiatry Associates is seeking a Credentialing & Enrollment Specialist to join our growing team! If you are a detail-oriented professional with experience in credentialing, compliance, and provider enrollment, this is your opportunity to make a meaningful impact in the field of mental health care.

Why Join Us?

At Rural Psychiatry Associates, our mission is to deliver high-quality mental health care to communities with limited access to services. We provide in-person and telemedicine care to patients of all ages through hospitals, clinics, schools, and senior living facilities across North Dakota, South Dakota, Montana, Minnesota, Utah, Alaska, and beyond.

As a Credentialing & Enrollment Specialist, you will play a crucial role in ensuring that our medical and professional staff are properly credentialed and enrolled with insurance payers. Your expertise will help maintain compliance with accreditation and regulatory requirements, allowing our providers to focus on delivering exceptional care.

The Role: What to Expect

• Location: Based in our Grand Forks, ND office.
• Credentialing & Compliance: Manage the credentialing and re-credentialing process for all medical and professional staff, ensuring adherence to regulations.
• Insurance Enrollment: Oversee provider enrollment with Medicare, Medicaid, Blue Shield, and other third-party payers.
• Regulatory & Accreditation Support: Maintain credentialing files, verify licenses, and assist with audits and inspections.

Key Responsibilities

• Distribute and process complete credentialing applications for medical staff seeking privileges at Rural Psychiatry Associates and affiliated healthcare facilities.
• Manage initial applications, reappointments, and temporary privileges according to policies, Medical Staff Bylaws, and regulatory agency standards.
• Prescreen applicants to ensure they meet the minimum criteria before initiating the credentialing process.
• Obtain and verify all necessary documents for credentialing, including licenses, certifications, and malpractice insurance.
• Maintain credentialing files and ensure accurate documentation for audits and accreditation inspections.
• Verify staff licenses and credentials for initial appointments, renewals, and temporary privileges.
• Submit completed credentialing materials to the Medical Director and flag any concerns for review.
• Monitor time frames for each step of the credentialing and enrollment process.
• Conduct ongoing queries with state agencies and the National Practitioner Data Bank (NPDB) regarding licensure and disciplinary actions.
• Ensure compliance with state and federal regulations, accreditation requirements, and Medical Staff Bylaws.
• Manage the facility's Continuing Medical Education (CME) functions and maintain related documentation.
• Coordinate credentialing committee meetings and take meeting minutes.
• Maintain an up-to-date physician database, including medical licenses, DEA certificates, liability insurance, and expiration dates.
• Provide training and education to medical staff on credentialing and enrollment processes as needed.
• Assist in the development and implementation of administrative policies related to credentialing and billing.

What We're Looking For

• High school diploma or equivalent required; associate's or bachelor's degree preferred.
• Previous experience in medical credentialing, provider enrollment, or healthcare administration required.
• Strong knowledge of credentialing requirements, regulatory compliance, and insurance payer enrollment.
• Excellent attention to detail and ability to manage multiple priorities in a fast-paced environment.
• Proficiency with credentialing databases, electronic health records (EHR), and Microsoft Office Suite.
• Strong organizational and time management skills.
• Ability to handle confidential information with professionalism and discretion.
• Knowledge of HIPAA regulations and medical staff bylaws.

What We Offer

As we support and care for our patients, we also prioritize the well-being of our team members. Our benefits include:

• Medical, Dental & Vision Insurance
• Long & Short-Term Disability Insurance
• Life Insurance
• 401(k) Retirement Plan
• Generous Paid Time Off (accrual based on hours worked)
• Paid Holidays

If you're looking for a rewarding career in healthcare administration where you can truly make a difference, apply today!