Credentialing Specialist

Why Join Us

Rural Psychiatry Associates is dedicated to providing high-quality mental health care to underserved communities across North Dakota, South Dakota, Montana, Minnesota, Utah, Alaska, and beyond. As a Credentialing & Enrollment Specialist, you will contribute to our mission by ensuring our medical and professional staff are properly credentialed and enrolled with insurance payers.

The Role: What to Expect

Based in our Grand Forks, ND office, the Credentialing & Enrollment Specialist will play a crucial role in maintaining compliance with accreditation and regulatory requirements. This position involves managing the credentialing and re-credentialing process, overseeing provider enrollment, and supporting regulatory and accreditation needs.

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.
• Cook up 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.
• Aid in the development and implementation of administrative policies related to credentialing and billing.

What We're Looking For

• A high school diploma or equivalent required; an 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

• 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