Kentucky Primary Care Association · 5 hours ago
Credentialing Manager
Frankfort, KY
Full-time
Hybrid
Entry, Mid Level
1+ years expKentucky Primary Care Association is a not-for-profit organization focused on improving access to primary health care services for underserved populations in Kentucky. The Credentialing Manager will oversee the credentialing lifecycle for providers, ensuring compliance with NCQA standards and managing primary source verification and continuous monitoring for licensure and other requirements.
Health CareMedicalNon ProfitPrimary and Urgent Care
Responsibilities
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
Qualification
Required
Hold your Certified Provider Credentialing Specialist (CPCS) or be willing to obtain it within KPCA required timeframe
Preferred
Bachelor's degree (or equivalent) in related field
At least 1 year's experience in a credentialing environment
Knowledge of credentialing policies and procedures, familiarity with URAC, NCQA, and/or JCAHO standards
Familiarity with state and federal regulations governing healthcare providers (Medicare, Medicaid, HIPAA, etc.)
Stand, walk, twist, bend, sit, enter data into a computer
Flexibility to work 40+ hours weekly, available to work Monday-Saturday as required
Benefits
Full medical, dental, and vision insurance.
401(k) match.
Generous PTO & Holiday calendar.
Company
Kentucky Primary Care Association
Kentucky Primary Care Association is a nonprofit organization that offers primary health care, advocacy, and medical support to society.
11-50 employees
Funding
Current Stage
Early StageLeadership Team
David Bolt
Chief Executive Officer
Molly Nicol Lewis
Chief Executive Officer
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