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Credentialing Specialist

Phoenix, AZ

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Description

A Credentialing Specialist is needed for a pharmaceutical and infusion company that serves throughout the US.  This position is out of the Phoenix location. (85054) 

The Credentialing Specialist is responsible for all aspects of the credentialing and re-credentialing of healthcare providers in compliance with state and federal standards. Tasks include:

 

JOB DESCRIPTION:

  • Work directly with Contracting/Credentialing Manager on daily assignments
  • Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications
  • Maintain internal provider grid to ensure all information is accurate and logins are available
  • Update each provider’s CAQH database file timely according to the schedule published by CMS
  • Apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance
  • Complete revalidation requests issued by government payers
  • Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid
  • Complete re-credentialing applications for commercial payers
  • Work closely with intake staff and billing staff to identify and resolve any denials or authorization issues related to provider credentialing
  • Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases
  • Identifying discrepancies in information and conducting follow-ups
  • Interacts with representatives from health plans to answer inquiries and clarify requirements

Job Requirements

REQUIREMENTS:

  • 2 years of credentialing experience preferred
  • 2 years’ experience in a medical practice business office role required
  • Knowledge and understanding of the credentialing process
  • Excellent computer skills including Excel, Word, and Internet use
  • Detail oriented with great organizational skills
  • Must possess problem-solving skills, be able to research, and multi-task
  • Plans and prioritizes to meet deadlines
  • Must possess good communication and follow-up skills
  • High School Diploma required
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