Provider, Facility and Ancillary credentialing, to include all aspects of the new applicant credentialing, re-credentialing; ongoing maintenance of provider credentials; report preparation, online verifications; administrative support of credentialing functions; assist in training new associates.
DEPARTMENT: Provider Relations
REPORTS TO: Director, Quality Improvement
Location: Phoenix, AZ
Candidate Education:Candidate Experience:
- Review new applications and supporting documents in a virtual environment and apply policy and criteria required for credentialing process.
- May perform required primary source verifications.
- Perform outreach to providers, licensure bodies and governmental agencies via phone, fax or written correspondence.
- Maintain and update credentialing database and core system records.
- Review monthly, or more often as appropriate, regulatory and disciplinary action reports issued by State licensure agencies, Federal and State authorities and the Office of Inspector General; identify affected providers and invoke the appropriate process as defined in policy and procedure.
- Maintain regulatory reports of provider sanctions and terminations.
- Review cases requesting termination, reinstatement or specialty changes and apply policy and criteria required for processing.
- Demonstrate knowledge of credentialing regulatory and accreditation requirements (NCQA, CMS, Medicaid, etc..).
- Perform other duties as assigned.
- 4 years of experience in a customer service or healthcare related position
- 1 year of experience in Credentialing
- Demonstrated written communication skills
- Demonstrated interpersonal/verbal communication skills
- Ability to work as part of a team
- Ability to move around office, use a telephone, computer, monitor, keypad and mouse
- Ability to effectively communicate interdepartmentally to facilitate work flow
- Ability sit for periods of up to 3 hours
Licenses and Certifications:
A license in one of the following is required:
- Certified Provider Credentialing Specialist
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook
- Ability to learn various software packages as may be necessary to perform job functions