What are the responsibilities and job description for the Credentialing Manager position at Kentucky Primary Care Association?
Apply here: https://www.kpca.net/jobs_search.asp
Position: Credentialing Manager Position Type: Full-time Exempt
Location: Hybrid (Remote Frankfort, KY as necessary)
About KPCA:
The Kentucky Primary Care Association was founded in 1976 as a not-for-profit 501 (c) (3) corporation of community health centers, rural health clinics, primary care centers, and all other organizations and individuals concerned about access to health care services for the state’s underserved rural and urban populations.
KPCA is charged with promoting the mutual interests of our members, with a mission to promote access to comprehensive, community-oriented primary health care services for the underserved.
Association members are providers of primary care – first contact, broadly trained physicians, physician assistants, nurse practitioners, behavioral health providers, dental providers, pharmacists, and other professionals delivering whole-person health care.
We support the development of primary care services throughout the Commonwealth by working with federal, state, and local legislators, regulatory agencies, health policy organizations, foundations, and payers to build a stronger primary care system in Kentucky.
About Role:
As the Credentialing Manager, you will report to the Director, Network Administration. The Credentialing Manager will lead the Credentialing Team with responsibilities that include but are not limited to: overseeing the full credentialing lifecycle for providers, including initial credentialing, recredentialing, and ongoing maintenance and ensuring compliance with NCQA standards and state, federal, and payer requirements. This role manages primary source verification and continuous monitoring for licensure, exclusions, sanctions, and adverse events, while maintaining complete, audit-ready files. The Credentialing Manager also supports and presents to the Credentialing Committee, leads and trains credentialing staff, and drives process improvement through workflow optimization and technology enhancements. The KPCA will employ the Credentialing Manager as an at-will employee.
Essential duties and responsibilities include, but are not limited to:
· Manage initial credentialing, recredentialing and maintenance of provider files for NCQA delegated credentialing with all KY MCOs.
- Maintain deep knowledge of NCQA standards and state/federal regulations; ensure all delegated activity aligns with NCQA accreditation & certification requirements.
- Oversee PSV processes: licensure, DEA, board certification, NPDB, OIG/SAM exclusion checks; maintain documentation within the NCQA-required timelines
- Conduct monthly monitoring for exclusions, license expiration, sanctions, malpractice claims, and adverse events, and report exceptions to the credentialing committee.
- Ensure complete, well-organized credentialing files; prepare documentation and audit trails for NCQA and delegated-payer audits; support annual internal audits.
- Prepare agenda, provider grids, adverse action documentation, and present data; attend monthly committee meetings to facilitate decisions.
· Supervise credentialing staff provide training on NCQA standards, process updates, and maintain team competency.
· Streamline workflows, implement automation, develop audit and reporting tools, troubleshoot credentialing systems, and support continuous improvement.
Key Competencies:
● Detail-oriented and focused on quality.
● Analysis and problem solving.
● Work independently as well as within team with various backgrounds.
● Excellent interpersonal, communication, presentation, and project management skills.
● Understanding of NCQA standards and guidelines.
● Ability to manage resources, independently and collaboratively organize a work priority schedule that is responsive to the KPCA CIN organizational strategies.
● Well-developed communication skills to clearly articulate policy, to collect data on providers, and to provide objective interpretation of data to providers and internal staff.
● Other duties as necessary.
Qualifications:
● Bachelor’s degree (or equivalent) in related field (preferred).
● At least 1 year’s experience in a credentialing environment preferred.
● Knowledge of credentialing policies and procedures, familiarity with URAC, NCQA, and/or JCAHO standards desired.
● Familiarity with state and federal regulations governing healthcare providers (Medicare, Medicaid, HIPAA, etc.)
● Hold your Certified Provider Credentialing Specialist (CPCS) or be willing to obtain it within KPCA required timeframe.
● Stand, walk, twist, bend, sit, enter data into a computer.
● Flexibility to work 40 hours weekly, available to work Monday-Saturday as required.
Our Mission:
Improving Kentucky’s capacity to care.
Our Values:
● Service.
● Community.
● Excellence.
● Integrity.
● Stewardship.
Compensation and Benefits:
● Competitive salary.
● Full medical, dental, and vision insurance.
● 401(k) match.
● Generous PTO & Holiday calendar.
● People-oriented culture.
This job description may not include all duties and responsibilities, the scope of which always remains subject to the direction of the KPCA and its Board of Directors. KPCA recognizes and appreciates the rich array of talents and perspectives that equal employment and diversity can offer our organization. KPCA is committed to making all employment decisions in accordance with federal, state, and local laws. No applicant shall be discriminated against in any terms, conditions or privileges of employment or otherwise be discriminated against because of the individual's race, creed, color, religion, gender, national origin or ancestry, age, mental or physical disability, sexual orientation, gender identity, genetic information, or veteran status. KPCA does not discriminate against any "qualified applicant with a disability" as defined under the Americans with Disabilities Act and will make reasonable accommodations when they do not impose an undue hardship on the organization.