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Credentialing Specialist

Phoenix, AZ

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Description

Busy and reputable specialty and pharmaceutical company in Phoenix (85054) in search of an experienced Credentialing Specialist.

The Credentialing Specialist will be responsible for all aspects of credentialing and re-credentialing of healthcare providers in compliance with state and federal standards.

The Credentialing Specialist responsibilities include:

  • Working 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
  • Other duties as assigned

Competitive compensation dependent on experience!

 

 

Job Requirements

REQUIREMENTS:

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

For consideration of this role, please apply, or email your resume to debbie.kempf@remx.com

In your email, please reference  Job Posting 746681 - Credentialing Specialist

 

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