Contract & Credentialing Coordinator

Basic Function: The Contract & Credentialing Coordinator oversees all aspects of credentialing, re-credentialing, and privileging for employee and consultant practitioners delivering patient care at the Seneca Nation Health System (SNHS). This role ensures all licensed and credentialed providers meet qualification standards within their scope of services and maintains up-to-date credentialing files and contract tracking.

Responsibilities

• Coordinates timely credentialing, re-credentialing, and privileging of Physicians, Dentists, Licensed Independent Practitioners, and Advanced Practice Professionals following National Committee for Quality Assurance (NCQA) standards.
• Performs Primary Source Verifications of practitioner information in compliance with NCQA and CMS standards.
• Enters, maintains, and updates practitioner information in electronic credentialing software accurately and promptly.
• Maintains current knowledge of Medical Staff Bylaws, Rules & Regulations, and Credentialing policies.
• Monitors practitioners due for re-credentialing and ensures timely completion.
• Completes and maintains accurate data for all employee and consultant practitioners.
• Contacts hospitals and agencies to verify information, including National Practitioner Data Bank (NPDB), state licensure, DEA verification, education, board certification, training, and references.
• Prepares and communicates correspondence to practitioners regarding application and re-credentialing outcomes.
• Maintains knowledge of accrediting bodies’ requirements and recommends best practices.
• Keeps copies of current state licenses, DEA certificates, malpractice coverage, and other required documents.
• Tracks expiration dates of licenses, DEA certificates, malpractice coverage, and contracts.
• Provides credentialing and privileging verifications.
• Reviews disciplinary action reports from state licensure bodies, Medicaid, and other agencies, escalating concerns to the Chief Medical Officer.
• Tracks annually required provider CEUs, including allowance and usage.
• Maintains practitioner contract files, notifies HR of rate increases, and schedules consultant hours and payments.
• Upholds and promotes the Seneca Nation Health System’s mission with integrity and positivity.
• Collaborates through a trauma-informed lens, emphasizing safety, transparency, and cultural sensitivity.
• Maintains a detailed log of practitioner administrative times for annual Medicare and Medicaid cost reports.
• Ensures confidentiality of all practitioner information.
• Attends mandatory staff meetings, trainings, and in-services.
• Follows all department, SNHS, and Seneca Nation policies.

Requirements

• Associate’s Degree with a minimum of three years’ office experience in a healthcare setting.
• NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) preferred, or equivalent with intent to pursue within the first year.
• Minimum of 2 years of credentialing experience in a hospital, academic medical center, outpatient setting, or Indian Health Service (IHS)/tribal health preferred.

Skills

• Experience with data entry and proficiency in Windows, Microsoft Word, Excel, and Outlook.
• Self-starter with the ability to work independently and collaboratively.
• Strong verbal and written communication skills with a professional demeanor.
• Ability to manage competing priorities.
• Knowledge of medical credentialing and privileging procedures and standards.

Benefits

• Monday - Friday schedule (no weekends or holidays).
• Full health, dental, and vision coverage for individuals; family option available.
• Short-term and long-term disability options.
• Annual vacation + PTO (accrued weekly).
• 16 paid holidays per calendar year.
• 401K with 5% matching.
• Parental, medical, education, and bereavement leaves.