Credentialing Specialist Tucson, AZ (Corporate-Bonita)
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Job Location:
Tucson, AZ - USA
Monthly Salary:
Not Disclosed
Posted on:
15 hours ago
Vacancies:
1 Vacancy
Job Summary
General Summary: Responsible for initiating coordinating monitoring and managing credentialing processes with contracted health plans. Facilitates all aspects of practitioner organizational and facility credentialing in accordance with state federal and health plan requirements. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies while developing and maintaining a working knowledge of the statutes and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing software system and management of related RESPONSIBILITIES:Ensures licensed independent practitioners medical providers therapeutic foster families and site foster families and site locations meet credentialing requirements as set forth by each contracted health plan including AHCCCS commercial and Medicare health plans. Collaborates with program managerand HR to compile and submit credentialing documents and applications necessary to implement the credentialing initial review of credentialing documents to ensure practitioner is in good standing with CAQH AHCCCS and licensing board(s).Identifies issues/discrepancies that require additional review and requests and/or updates for Medicare AHCCCS IDs CAQH NPI and other steps needed for the credentialing re-credentialing activities upon request and within time frames specified by the health plan. Manages and maintains credentialing files and/or profiles as needed to ensure provider information is accurate and up to tracks and monitors provider credentialing/re-credentialing applications from submission to credentialing software with current provider and site information. Responds to inquiries from healthcare organizations interfaces with internal and external customers as needed. Creates and distributes credentialing status reports on a regular reconciliation and maintenance activities of health plan directories/rosters as required by health on-going credentialing audits; conducts internal file query report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement the initial reappointment and expirable process for all Behavioral Health Medical Professionals and Independently Licensed Professional staff ensuring compliance with regulatory bodies (Joint Commission NCQA URAC CMS federal and state) as well as Medical Staff Bylaws Rules and Regulations policies and procedures and delegated contracts. Professionals and Independently Licensed Professional staff ensuring compliance with regulatory bodies (Joint Commission NCQA URAC CMS federal and state) as well as Medical Staff Bylaws Rules and Regulations policies and procedures and delegated contracts. Responsible for following all policies procedures and controls established by the organization the HIPAA Privacy Officer and/or the HIPAA Security Officer regarding access to protection of of and the use of the :Education High School Diploma or GED At least 3 (three) years of experience in a health care environment performing provider enrollment credentialing and/or some contracting tasks preferably with a behavioral health agency or health degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year about this position Contact us
Required Experience:
IC
Key Skills
About Company
Looking to build a lasting career? Join a team that is inclusive and embraces all individuals . Intermountain Centers is one of the largest statewide behavioral health and integrated care organizations in Arizona. What does building a lasting career look like? Top-level compensation p ... View more
