Credentialing Specialist

Location: Scottsdale, AZ
Date Posted: 07-24-2017
POSITION SUMMARY: 

The Credentialing Specialist is responsible for credentialing and recredentialing practitioners as well as enrollment with participating client health plans. Functions include, but are not limited to, processing applications, performing primary source verifications and updating and maintaining database.

ESSENTIAL JOB FUNCTIONS: 

• Perform the initial credentialing and recredentialing functions for employed and contracted practitioners.
• Review practitioner applications for completion and accuracy.
• Maintain timely and accurate data entry and periodically revise practitioner data.
• Ensure timely and accurate credentialing and recredentialing application submissions for each practitioner.
• Enroll practitioners with all appropriate client health plans.
• Ensure all practitioners who require collaboration agreements are appropriately assigned to a physician.
• Respond to all practitioners, client health plan and internal inquiries in a timely manner. 
• Monitor expiring licensure, board and professional certifications and other expirable documents with practitioners.
• Conduct sanctions and compliance monitoring and alert managers of any undisclosed negative findings. 
• Assist traveling practitioners with obtaining new state licenses in areas identified by the clinical management team.

EXPERIENCE:
• Associates in Business, Health Care or related field or high school diploma and relevant combination of education and experience. 
• Experience with medical and professional credentialing processes, policies and procedures.
• Familiarity with practitioner billing and claims payment system requirements as related to practitioner enrollment. 
• Up to three years credentialing experience in a health care setting.

PREFERRED EXPERIENCE
• Certified Practitioner Credentialing Specialist (CPCS). 
• Experience with MD-Staff or similar practitioner credentialing, data collection and record management system. 
• Experience with National Committee for Quality Assurance, URAC and/or The Joint Commission guidelines.
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