Credentialing Process Manager

3 days ago


Flagstaff, Arizona, United States Northern Arizona Healthcare Corporation Full time
Job Overview

We are seeking a skilled Credentialing Process Manager to support our business operations and execute the strategic business plan. This role will lead day-to-day functions, provide reporting, and manage program monitoring for services delivered through contracted entities.


Key Responsibilities
  • Adhere to NCQA guidelines and audit provider licensure files accordingly.
  • Pull On-Going Files in accordance with NCQA guidelines and maintain a thorough understanding of Initial and Re-Credential Delegated files.
  • Prepare and distribute facility and provider applications to payers, coordinate and monitor all credentialing and re-credentialing processes, and upload new documents to the system.
  • Maintain ongoing interaction with payers, assist offices and internal departments with credentialing issues, and source effective dates from payers.
  • Notify relevant parties of effective dates, keep records in licenses, credentials, and insurance contracts, and be responsible for all insurance changes.

The ideal candidate will have a strong background in healthcare credentialing, excellent communication skills, and proficiency with Microsoft Office products, including Word and Outlook.


Qualifications
  • High School Diploma required; Certified Provider Credentialing Specialist (CPCS) preferred.
  • Minimum 2-3 years' experience in Healthcare Credentialing, preferably with Certified Provider Credentialing Specialist (CPCS) certification.
  • Experience in Health Plan Delegation is a plus.
  • Ability to prioritize tasks, work independently, and meet deadlines is essential.

$65,000 - $85,000 per year based on qualifications and location.



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