Credentialing Specialist

Job Description

Job Description

As a Credentialing Specialist, you will play a pivotal role in coordinating and overseeing the credentialing and re-credentialing processes for practitioners.

Responsibilities :

Process credentialing applications and maintain the credentialing database according to internal policies and procedures.

Ensure all credentialing processes comply with state statutes and regulatory agencies, including NCQA, URAC, CMS, The Joint Commission, and the Arizona and Utah Department of Health Services (DHS).

Generate and maintain forms, letters, checklists, and an internal tracking database to ensure accurate and complete data entry.

Generate reports for tracking expiring licenses and certifications, and conduct internal and external validation of credentialing file audits.

Serve as a liaison between HR, Quality Management (QM), and the Business Office, facilitating the flow of credentialing information.

Assist the Business Office staff and HR team with tracking and renewing licenses, professional liability, and certifications for all providers.

Qualifications :

Minimum of 3 years in relevant credentialing experience, with a preference for familiarity with CMS, AHCCCS, NCQA, URAC, and The Joint Commission guidelines.

High School Diploma or equivalent required; an Associate's Degree is preferred.

Certified Practitioner Credentialing Specialist (CPCS) preferred.

Proficiency with MD / Staff or similar credentialing data collection and record management systems, and experience in multi-state credentialing and provider enrollment.

Onsite , Phoenix, AZ 85016

Monday to Friday

Pay Details : $21.00 to $23.00 per hour

Search managed by : Joanna Calderon

Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan.

Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs.

In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.

Equal Opportunity Employer / Veterans / Disabled

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The Company will consider qualified applicants with arrest and conviction records subject to federal contractor requirements and / or security clearance requirements.