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.

  • 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

  • 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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