Credentialing & Billing Specialist

The Credentialing & Billing Specialistcoordinates 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%.

QUALIFICATIONS

• High school diploma required.
• Minimum 2 years’ credentialing, billing, or healthcare operations experience.
• Knowledge of Medicare, Medicaid, commercial payer enrollment, and Tribal/IHS billing practices.
• Experience with credentialing databases (e.g., CAQH, PECOS – Provider Enrollment, Chain, and Ownership System).
• Understanding of provider types, specialties, and scope of practice requirements across Tribal/IHS settings.
• Familiarity with Resource and Patient Management System (RPMS), Cerner, Epic, or other EHRs used in Tribal/IHS environments.
• Ability to interpret payer policies, enrollment requirements, and documentation standards for federal contracting environments.
• Experience with EHR/PM systems in multi-contract environments preferred.

PHYSICAL REQUIREMENTS

Physical job requirements encompass a range of activities that may be necessary for various roles. These can include, but are not limited to:

• Lifting and Carrying: Ability to lift and transport objects up to 25 pounds occasionally.
• Standing and Walking: Position may require prolonged periods of standing or walking.
• Bending and Stooping: Ability to bend, stoop, and crouch as needed.
• Reaching and Pushing/Pulling: Ability to reach for items and move office equipment as necessary.
• Sitting: Ability to sit for extended periods while performing administrative and computer-based work.

EQUAL OPPORTUNITY & TRIBAL PREFERENCE STATEMENT

Kahtnuht’ana Development Corporation (KDC) is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other protected status.

In accordance with applicable federal law, preference will be given to qualified Kenaitze Indian Tribe members.