Credentialing Coordinator

LHH; Phoenix (AZ); On-site; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare organization is seeking a Credentialing Specialist to oversee and coordinate the credentialing processes for practitioners with various health plans. This role is crucial in ensuring compliance with state regulations and maintaining the integrity of credentialing applications. The ideal candidate will have experience in credentialing, strong attention to detail, and expertise in data management systems.

Benefits

Medical, dental, vision insurance

401K plan

Paid Sick Leave

Short-term disability

Commuter benefits

Qualifications

• Minimum of 2 years relevant credentialing experience.
• Familiarity with CMS, AHCCCS, NCQA, URAC guidelines required.
• Proficient in credentialing data management and multi-state enrollment.

Responsibilities

• Process and maintain credentialing applications according to policies.
• Ensure compliance with regulatory agencies.
• Serve as liaison between departments for credentialing information.

Skills

Credentialing Experience

Compliance Knowledge

Data Management

Communication

Education

High School Diploma or equivalent

Associate's Degree

Tools

MD / Staff systems

Job description

As a Credentialing Specialist, you will play a pivotal role in coordinating and overseeing the credentialing and re-credentialing processes for practitioners with contracted Managed Care Organizations (MCOs), Medicare / Medicaid, and Commercial health plans.

Key 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 2 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.
• 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 85009

Monday to Friday

Pay Details : $ to $ 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.

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Credentialing Coordinator • Phoenix, Arizona