Tribal Revenue Cycle Optimization & Credentialing Specialist

Job Summary: The Tribal Revenue Cycle Optimization & Credentialing Specialist is a non-management, individual contributor role responsible for providing on-site revenue cycle optimization support for tribal health programs while also performing hands-on provider credentialing and enrollment activities. This role is approximately 50% travel, consisting primarily of week-long on-site visits to tribal health locations, and 50% remote work focused on credentialing, enrollment, and related revenue cycle support. This position is execution-focused and combines field-based revenue cycle optimization with detailed, production-level credentialing and enrollment work.Key ResponsibilitiesOn-Site Revenue Cycle Optimization & Support (Approximately 50% of role)Conduct comprehensive assessments of current revenue cycle processes at tribal health facilities, including patient registration, charge capture, coding (ICD-10-CM, CPT, HCPCS), claims submission, denial management, appeals, collections, and payment posting.Identify bottlenecks, compliance risks, reimbursement gaps, and opportunities for optimizationDevelop and recommend data-driven strategies, workflows, and best practices to maximize third-party revenue, minimize denials, accelerate cash flow, and ensure accurate reimbursement.Collaborate with tribal health leadership, billing teams, clinical staff, and external payers to implement process improvements, system enhancements (e.g., EHR/Practice Management optimization), and training programs.Analyze revenue cycle performance metrics, denial trends, aging reports, and financial data to produce actionable reports and recommendations for tribal administrators.Provide on-site support and training at tribal clinics and facilities to build internal capacity, improve staff competency in coding, billing compliance, and denial prevention.Ensure all optimization efforts align with federal regulations (e.g., HIPAA, CMS guidelines), tribal policies, and cultural sensitivities in healthcare delivery.Monitor post-implementation results, track key performance indicators (KPIs) such as days in A/R, clean claim rates, denial percentages, and collection rates, and adjust strategies as needed.Stay current on evolving payer policies, tribal health funding models, and revenue cycle technologies relevant to Indian Country.Travel 50% to tribal locations for assessments, training, implementation, and follow-up visits.Credentialing & Enrollment Responsibilities (Approximately 50% of role when not traveling)Perform end-to-end provider credentialing and enrollment activities for tribal health programs.Complete initial enrollments, revalidations, and maintenance for providers with Medicare, Medicaid, and commercial payers.Prepare, submit, and track enrollment and credentialing applications; follow up with payers to resolve issues and ensure timely approvals.Maintain accurate provider enrollment records, credentialing files, and revalidation timelines.Coordinate with providers, tribal health leadership, and internal teams to obtain required documentation and signatures.Troubleshoot enrollment-related payment issues and support resolution of claims impacted by credentialing or enrollment status.Ensure compliance with payer requirements, CMS regulations, and applicable tribal policies.QualificationsBachelor’s degree in healthcare administration, Business, Finance, Health Information Management, or a related field. Equivalent experience in tribal healthcare may substitute.Minimum 5 years of progressive experience in healthcare revenue cycle management, with at least 3 years focused on optimization, consulting, or process improvement.Minimum of 3–5 years of experience in healthcare revenue cycle operations, billing, coding, and/or provider credentialing and enrollment.Demonstrated experience with provider enrollment for Medicare, Medicaid, and commercial payers.Prior experience in tribal health, Indian Health Service (IHS), tribal clinics, or FQHC settings strongly preferred.In-depth knowledge of medical coding (ICD-10, CPT, HCPCS), billing regulations, payer requirements (Medicare, Medicaid, commercial), denial management, and claims adjudication.Familiarity with tribal-specific revenue considerations, including IHS/Tribal/Urban (I/T/U) billing, PRC, and third-party liability recovery.Proficiency in EHR/Practice Management systems (e.g., RPMS, eClinicalWorks, EPIC) and revenue cycle analytics tools.Strong analytical, problem-solving, and project management skills with the ability to interpret data and drive measurable improvements.Excellent communication and interpersonal skills to work effectively with diverse tribal stakeholders, clinical teams, and leadership.Certification such as CPC, CPMA, CRCR, or equivalent revenue cycle credential preferred.Approximately 50% travel, primarily consisting of week-long on-site visits to tribal health locations.Ability to travel domestically as needed and work independently while on-site.Combination of on-site work at tribal health facilities and remote work from a home office.This is an exempt, salaried, non-management position.Must respect and uphold tribal sovereignty, cultural protocols, and confidentiality in all interactions.Preferred SkillsExperience leading cross-functional teams or consulting projects in revenue cycle improvement.Knowledge of federal Indian health policy and funding mechanisms.Proficiency in data analysis tools (e.g., Excel, or reporting software).This role offers the opportunity to make a meaningful impact on tribal health sustainability while working in a culturally respectful environment. Competitive salary, benefits, and travel support provided.

Salary : $55,000 - $60,000