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Phoenix, Arizona, United States LHH Recruitment Solutions Full timeAs a Credentialing Specialist, you will play a pivotal role in coordinating and overseeing the credentialing and re-credentialing processes for healthcare professionals. Responsibilities: Process credentialing applications and maintain the credentialing database according to internal policies and procedures. Ensure all credentialing processes comply with...
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Regional Credentialing Coordinator
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Medical Credentialing Specialist
2 months ago
We are seeking a highly organized and detail-oriented Credentialing Specialist to join our team at LHH Recruitment Solutions. As a Credentialing Specialist, you will play a pivotal role in coordinating and overseeing the credentialing and re-credentialing processes for healthcare practitioners.
Key Responsibilities- Credentialing and Re-Credentialing: Process credentialing applications and maintain the credentialing database according to internal policies and procedures.
- Compliance and Regulatory Affairs: Ensure all credentialing processes comply with state statutes and regulatory agencies, including NCQA, URAC, CMS, The Joint Commission, and the Arizona and Utah Department of Health Services (DHS).
- Documentation and Reporting: Generate and maintain forms, letters, checklists, and an internal tracking database to ensure accurate and complete data entry. Generate reports for tracking expiring licenses and certifications, and conduct internal and external validation of credentialing file audits.
- Interdepartmental Collaboration: Serve as a liaison between HR, Quality Management (QM), and the Business Office, facilitating the flow of credentialing information.
- Provider Support: Assist the Business Office staff and HR team with tracking and renewing licenses, professional liability, and certifications for all providers.
- Experience: Minimum of 3 years in relevant credentialing experience, with a preference for familiarity with CMS, AHCCCS, NCQA, URAC, and The Joint Commission guidelines.
- Education: High School Diploma or equivalent required; an Associate's Degree is preferred.
- Certifications: Certified Practitioner Credentialing Specialist (CPCS) preferred.
- Technical Skills: Proficiency with MD/Staff or similar credentialing data collection and record management systems, and experience in multi-state credentialing and provider enrollment.
