CREDENTIALING SPECIALIST

Arizona State Government; Phoenix (AZ); On-site; USD 61,000 - 62,000; Full time

Benefits offered by this job

Medical Insurance

ASRS Retirement

Paid Holidays

Parental Leave

Tuition Reimbursement

Wellness Plans

Job summary

The Arizona Department of Economic Security (DES), Division of Developmental Disabilities, is seeking a Credentialing Specialist to join a dedicated team helping Arizonans thrive. You will manage credentialing activities, ensure AHCCCS compliance, and lead QA processes that uphold program quality and integrity.

The role requires strong data analysis, staff supervision, and collaboration with health plans and contracts.

Qualifications

• Credentialing and QA knowledge, QA programs and risk assessment.
• Data analysis, summary report writing, corrective action plan development.
• Ability to train staff and lead QA committees.

Responsibilities

• Oversee credentialing of Qualified Vendor Agencies and maintain credentialing calendar.
• Supervise QA Unit staff including hiring, training, and performance reviews.
• Coordinate QM standards and AHCCCS policy compliance.
• Prepare agendas, minutes, and report to Credentialing Committee.

Skills

Credentialing

Quality assurance

Quality management

Quality improvement

Data analysis

Auditing

Education

CPHQ certification

Tools

Microsoft Office Suite

AHCCCS systems

Job description

DEPARTMENT OF ECONOMIC SECURITY

Your Partner For A Stronger Arizona.

DES works with families, community organizations, advocates and state and federal partners to realize our collective vision: A thriving Arizona.

DES serves more than 3 million Arizonans. Our Mission is to strengthen individuals, families, and communities for a better quality of life.

CREDENTIALING SPECIALIST

Job Location:

Division of Developmental Disabilities (DDD)

4000 North Central Avenue, Phoenix, Arizona 85012

Posting Details:

Salary: $60,800 - $62,000

Grade: 21

Closing Date: September 11, 2026

Job Summary:

Would you like to be part of an amazing team that helps Arizonans thrive? At the Department of Economic Security (DES), we strengthen individuals, families, and communities for a better quality of life. DES is looking for individuals that are committed to service, community, and teamwork. To learn more about DES please visit des.az.gov or click on the link here to view ‘Our DES’ video.

The Department of Economic Security, Division of Developmental Disabilities (DDD), is seeking an experienced and highly motivated individual to join our team as a Credentialing Specialist. DDD provides individuals with developmental disabilities, and their families, services and supports that are flexible, high quality, and member driven. These services provide individuals with opportunities to exercise their rights and responsibilities of independent decision-making and engagement in the community.

Applicants for this position cannot be licensed or certified by the DDD Office of Licensing Certification and Regulation, cannot have a principal interest in or have a spouse or close family with principal interest in a DDD Qualified Vendor Agreement, and cannot be employed or subcontracted by a DDD Qualified Vendor.

Job Duties

Essential Duties and Responsibilities include but are not limited to:

• AHCCCS compliance w/ credentialing of Qualified Vendor Agencies contracted w/ DDD, policies/procedures, review, maintaining credentialing calendar, completing monthly/quarterly organizational initial & re-credentialing in preparation for the Med. Officer's & Credentialing Committee's review/approval, coordinating w/ the Contracts Unit for required credentialing docs., review all required primary sources for licensing, HCBS certification, etc.
• Responsible for all duties/responsibilities for the supervision of staff in the QA Unit. Includes hiring, training, 1:1 meetings, coaching, day to day oversight, completing Performance Appraisals (MAP), authorizing leave, approving ETE Time Cards, etc.
• Responsible for coordinating QM Standards in regards to credentialing with AHCCCS Chapter 950 policies compliance, including submitted data review, completing internal review tool, analyzing data, review with Health Plan Credentialing staff, and imposing possible corrective actions/compliance follow-up for the Division and the contracted Health Plans.
• Prepares agenda, minutes, files and facilitates the Credentialing Committee. Ensures confidentiality statements are current and members adhere to confidentiality. Completes all follow-up as assigned and reports back to the Committee.
• Responsible for the Division's AHCCCS 950 Exhibit Quarterly Report compiling the quarterly provisional, initial, & re-credentialing data end summaries for the Division & contracted health plans for the Medical Officer's review & signature. Process includes reviewing timeliness compliance with AHCCCS Policy 950 & providing data to the Medical Officer for review with the Health Plans' respective Credentialing Committees.
• Responsible for the completion of all required training, participation in unit meetings and various QA committees: SQMC, Peer Review, COQOC, etc. Develops publications as requested. Participates in ad hoc work groups and committees as requested.
• Completes activities associated w/contract deliverables including but not limited to monitoring AdSS during ORs & Oversight Meetings; reviews & evaluates documents, reports, & deliverables submitted by AdSS; aggregates AdSS info into Div deliverables w/AHCCCS; ensures timelines are met; reviews & is very knowledgeable of AHCCCS contract w/Division especially related to areas of your expertise & authority.

Knowledge, Skills & Abilities (KSAs)

Knowledge in:

• Credentialing, quality assurance, quality management, quality improvement, risk assessment and prevention.
• Data analysis, summary report writing, corrective action plan development, prevailing concepts and philosophies regarding developmental disabilities.
• Adult learning strategies utilized in the course of providing training.
• Organizational and corporate structures and management practices and procedures typically utilized in facilities that serve individuals with developmental disabilities.
• Contracting.

Skills in:

• Oral and written communication and documentation.
• Public speaking.
• Analyzing large amounts of data.
• Educating and assisting Division staff, providers, and members on various quality management activities.
• Report writing Facilitating meetings; Providing leadership to employees.
• Interpreting contracts; Technical writing.

Ability to:

• Learn and interpret Arizona Health Care Cost Containment System (AHCCCS) requirements, credentialing requirements.
• Center for Medicare and Medicaid Services grants requirements, and federal and state laws.
• Utilize computer technology (e.g., developmental database development and maintenance, desktop publishing, Microsoft Office Suite, etc.)

Selective Preference(s)

• A Certified Professional in Healthcare Quality (CPHQ) certification.

Pre-Employment Requirements

• If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Driver’s License Requirements. Any employee operating a motor vehicle on State business must possess and retain a current, valid class-appropriate driver’s license, complete all required training, and successfully pass all necessary driver license record checks. The license must be current, unexpired, and neither revoked nor suspended. Employees who drive on state business are subject to Driver's license record checks, must maintain acceptable driving records, and must complete all required driver training. An employee who operated a personally owned vehicle on state business shall maintain the statutorily required liability insurance (see Arizona Administrative Code (A.A.C.) (R2-10-201.11)).
• Successfully pass background and reference check; employment is contingent upon completion of the above-mentioned process and the Agency's ability to reasonably accommodate any restrictions.
• All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).
• In accordance with the Arizona Health Care Cost Containment System contract as defined in 42 CFR 455,104, SMDL #09-001) a search for the incumbent will be conducted monthly using the List of Excluded Individuals and Entitles (LEIE) and the System for Award Management (SAM).

Benefits

• Affordable medical, dental, life, and short-term disability insurance plans
• Participation in the Arizona State Retirement System (ASRS) and long-term disability plans
• 10 paid holidays per year
• Paid vacation and sick time
• Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child.
• Deferred compensation plan
• Wellness plans
• Tuition Reimbursement
• Stipend Opportunities
• Infant at Work Program
• Rideshare and Public Transit Subsidy
• Career Advancement & Employee Development Opportunities

Learn more about the Paid Parental Leave program here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Retirement

State employees are required to participate in the Arizona State Retirement System (ASRS), the State sponsored retirement contribution plan and the Long-Term Disability (LTD) program after a 27-week waiting period. The ASRS defined benefit plan provides for life-long income upon retirement. You will also have the option to participate in a voluntary deferred compensation program to take advantage of tax-deferred retirement investments.

On, or shortly after, your first day of work you will be provided with additional information about the available insurance plans, enrollment instructions, submission deadlines and effective dates.

Contact Us

For questions about this career opportunity, please contact Shobana Jeyaraj at 480-915-7157 or [e-mail].

The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer. Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 480-915-7157 or [e-mail]. Requests should be made as early as possible to allow time to arrange the accommodation.