Our mission is to provide excellent, compassionate care to our patients, their families, and visitors. The responsibility of the Credentialing Specialist is to perform essential credentialing functions. This position reports to the Credentialing and Compliance Manger and works closely with Operations teams to ensure tasks are completed before deadlines. This position will be fully remote after a successful 90 day training period.

DUTIES AND RESPONSIBILITIES

• Responsible for renewing all Licenses, DEA, Business License, Professional Memberships, Certifications, Malpractice, Immunizations, CME/CEU, and Board Certifications
• Monthly sanction, debarment, and exclusion checks, including SAM, OIG and OFAC
• Responsible for all provider and business demographic updates within the Credentialing Platform
• Maintaining the Monthly Monitoring Report
• Complete Provider Employment Verifications
• Responsible for PA Delegation Agreements
• Responsible for scheduling/Agenda Items /Minutes for Payor Meeting and other department meetings
• Responsible for communicating and sending out Payor Newsletters out to the organization
• Maintain Payor and Hospital Contact list within the credentialing software program
• Responsible for maintaining, updating, and sending out monthly/quarterly rosters to payors
• Responsible for sending out Term notifications
• Responsible for all provider name changes for payors and facilities
• Maintain Fax lines and distribute out to the appropriate department
• Monitor the Care Concern email address and addressing the concerns in a time manner.
• Responsible for all Payor Grievances, including follow-ups and resolution of the concern
• Maintain and update providers CAQH profiles (every 120 days)
• Assist in Initial and Recredentialing for Payor and Facility Credentialing
• Updates multiple platforms within the organization to keep data current
• Completes prioritized tasks within the department timeframes
• Promote a positive attitude, teamwork, and fun in the workplace

· Works independently and multi-tasks

· Communicates and work effectively with other employees, providers, and health plans

· Maintain and ensures strict confidentiality of information and files

QUALIFICATIONS

Credentialing Specialist Skills and Qualifications

· Medical Terminology

· Ability to meet strict deadlines

· Attention to detail

· Great Communication and Organization skills

· High proficiency with MS Office (Word, Excel, PowerPoint, Outlook etc.).

· Strong Computer Skills

· Proficiency in databases management (Modio/MD Staff)

· Problem Solving

· Team Collaboration

Minimum Qualifications

· High School Diploma or equivalency.

· 2-3 years of Credentialing Experience

· Understanding of laws, regulations, and procedures of NCQA

· Highly proficient in Excel, Word, Outlook, and PowerPoint

· Skilled with computer databases

Job Type: Full-time

Benefits:

• 401(k)
• AD&D insurance
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible schedule
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work Location: Hybrid remote in Phoenix, AZ 85018

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