Credentialing Coordinator

Hello humankindness

Located conveniently in the heart of Phoenix Arizona St. Josephs Hospital and Medical Center is a 571-bed not-for-profit hospital that provides a wide range of health social and support services. Founded in 1895 by the Sisters of Mercy St. Josephs was the first hospital in the Phoenix area. More than 125 years later St. Josephs remains dedicated to its mission of caring for the poor and underserved.

We are extremely proud to be a nationally recognized center for quality quaternary care medical education and research. St. Josephs includes the internationally renowned Barrow Neurological Institute Norton Thoracic Institute Cancer Center at St. Josephs Ivy Brain Tumor Center and St. Josephs Level I Trauma Center (which is verified by the American College of Surgeons). The hospital is also a respected center for high-risk obstetrics neuro-rehabilitation orthopedics and other medical services. St. Josephs is considered a sought-after destination hospital for treating the most complex cases from throughout the world. Every day approximately 20 percent of the hospitals patients have traveled from outside of Arizona and the United States to seek treatment at St. Josephs.

U.S News & World Report routinely ranks St. Josephs among the top hospitals in the United States for neurology and addition St. Josephs boasts the Creighton University School of Medicine at St. Josephs and a strategic alliance with Phoenix Childrens Hospital.

St. Josephs is consistently named an outstanding place to work and one of Arizonas healthiest employers. Come grow your career with one of Arizonas Most Admired Companies. Look for us on Facebook and follow us on Twitter.

Job Summary:

Coordinates credentialing activities; including data entry and physician database maintenance; credentialing processes reappointment credentialing expirables and other duties that support provider on-boarding activities. Serves as effective liaison between the provider and the facility throughout the credentialing process. Responsible for understanding State and Federal Regulatory Agencies requirements accreditation compliance and other critical matters that affect the healthcare environment. Performs other duties as assigned in an effective competent manner.

Essential Function:

• Maintains up-to-date physician database of all applications enrollment status demographics medical licenses drug enforcement administration certificates professional liability insurance etc.
• Responsible for the accuracy and integrity of data entered into the credentialing database system.
• Assist in designing/compiling other data supporting various statistics utilized internally to monitor operations.
• Responsible for continuous collection of information required to comply with delegated agreements and credentialing policies.
• Conducts credentialing database training for new hires and refresher training for existing staff. Provides input for training materials and job aids.
• Reviews applications and other data sources for accuracy and completeness prior to submitting to Health Plan.
• Acts as liaison with Health Plan representatives regarding individual credentialing applications; audits; provider load confirmation; fee schedule load issues; and addressing potential corrective action plans and monitoring for a successful resolution.
• Maintains relationships with office personnel Legal Regulatory and Health Plans Provider Relations department to provide and/or obtain documentation pertinent to timely and accurate completion of the delegated credentialing process.

**Candidates must currently reside in Arizona

Minimum

• High School Diploma/GED.

• Three (3) years experience in a Health Care Plan Credentialing/Provider Relations and/or auditing setting or Health Care Enrollment.

Preferred

• Bachelors degree preferred

• Certified Professional Medical Services Management (CPMSM) and/or Certified Provider Credentialing Specialist (CPCS) Certification preferred.

Knowledge Skills and Training:

• Proficient with CACTUS Software or similar credentialing system Intermediate Microsoft programs skills (MS Word Excel Power Point).
• Knowledge of NCQA standards and Joint Commission standards.
• Knowledge of commonly-used concepts practices and procedures used in health care and physician credentialing.