Credentialing Specialist/ Contract Reviewer

Responsible for all aspects of the credentialing, re-credentialing and privileging processes for all medical practitioners providing member care at Southwest Network.

Ensures practitioners are credentialed, affiliated and approved with health plans and all appropriate sites. Maintains up-to-date data for each practitioner in credentialing databases and online systems, plus renews licenses and certifications in a timely manner.

All members of our team are expected to provide support and services in accordance with the Nine Guiding Principles for Recovery Oriented Adult Behavioral Health Services and Systems and practice in a manner that is consistently mindful of the 12 Principles of The Arizona Vision for Children.

A complete job description is available upon request.

REQUIREMENTS

Education, Certification, and Experience Requirements

• High School diploma or equivalency certificate required; associates degree preferred.
• Two (2) years relevant credentialing experience preferred.
• Two (2) years contract reviewing experience preferred.
• Knowledge and understanding of the medical credentialing process, DEA certification, and CAQH and NHSC requirements preferred.
• Knowledge of local, state, and national contract laws.
• Must maintain a valid Arizona state fingerprint clearance card.
• Must be at least 21 years of age.

Knowledge, Ability, and Skills

• Requires the ability to research and analyze data and excellent attention to detail.
• Must be ale to establish and maintain effective communication and working relationships with medical practitioners, contractors, management and staff, as well as contracts outside the organization.
• Must possess excellent customer service skills
• Requires strong writing, verbal and interpersonal communication skills.
• Strong organizational skills and the ability to utilize multiple types of office equipment (i.e. phones, copier, fax, etc.)
• Ability to type 25 to 40 WPM is preferred
• Must be able to utilize the internet and various web browsers

COMPENSATION and BENEFITS

• This position is offered at a fair, competitive salary.
• Medical, Dental, and Vision insurance
• Health Savings and Flex Spending account options
• Paid sick, vacation and holiday time (10 paid holidays per year!)
• Tuition reimbursement
• Retirement plan (403b) with company match
• Disability insurance
• Basic life insurance with the option to purchase supplemental insurance
• Employee Assistance Program
• Employee Discounts

When you consider everything the salary, the benefits, the ongoing training and support we offer, and the impact you’ll have on the lives of others it could be the right opportunity for you.

Any offer of employment is contingent upon verification of education, employment, driving record and auto insurance, and completion of a criminal background check and drug testing.