Credentialing Specialist

Phoenix, AZ 85004

Job Category: Administrative & Professional Job Number: 21062

Job Description


We are looking for a Credentialing Specialist for an established healthcare provider located in Phoenix. This role is responsible for credentialing and re-credentialing providers in the Network as well as ensuring enrollment with participating client health plans. Credentialing functions include, but are not limited to, processing credentialing/re-credentialing applications, performing primary source verification' s and updating and maintaining the Vistar eVIPs credentialing database in accordance with internal policies and procedures, client health plan contracts, URAC measures and standards and applicable state and federal regulations.

Responsibilities:
  • Perform initial credentialing/re-credentialing in accordance with URAC standards
  • Gather & verify highly confidential health care practitioner credentials
  • Monitor expiring licensure, board and professional certifications
  • Manage practitioner data files for Q Point clients; utilize Vistar eVIPs and primary source databases
  • Conduct sanctions & compliance monitoring - Keep Supervisor informed of potential credentialing or verification issues

Requirements:
  • Associate degree or equivalent experience
  • Minimum of three (3) years of experience with multi-specialty credentialing
  • Proficiency with MS Office applications and web-based technologies

Highly Preferred Qualifications:
  • Certified Provider Credentialing Specialist (CPCS)
  • Experienced with Credentialing MSO databases


$18.50 – 20 hour DOE

Direct Hire position

Will work on-site in Phoenix offices

Meet Your Recruiter

Laura Piel

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