Credentialing Specialist, Robert Half

Credentialing Specialist

Robert Half

Location:

United States, Phoenix, AZ

Category:

Insurance

Contract Type:

Not provided

Salary:

Not provided

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Job Description:

We are in search of a Credentialing Specialist to join our team based in Phoenix, Arizona. As a Credentialing Specialist, you will be pivotal in managing all facets of provider credentialing, re-credentialing and payer enrolment within a healthcare setting. This role offers a contract to permanent employment opportunity in the healthcare industry.

Job Responsibility:

Oversee the credentialing process for new providers
Prepare and submit credentialing applications
Monitor and manage the status of applications
Handle the re-credentialing process for existing providers
Coordinate provider enrolment with different insurance payers
Maintain accurate records of all payer contracts and provider enrolments
Review and interpret payer contracts
Ensure adherence to all federal, state, and payer-specific regulations
Maintain meticulous documentation of all credentialing and enrolment activities
Conduct regular audits of credentialing files
Act as the primary contact for providers, payers, and internal staff
Collaborate with clinical and administrative staff
Provide training and guidance to staff
Generate reports on credentialing and payer enrolment activities
Analyze trends and identify areas that need improvement

Requirements:

Proven experience in credentialing, preferably within the healthcare sector
Proficiency in Customer Relationship Management (CRM) software
Demonstrable experience in auditing processes and documentation
Strong understanding of compliance regulations in the healthcare industry
Familiarity with the Council for Affordable Quality Healthcare (CAQH) procedures
Proficient in managing and executing credentialing processes

What we offer:

Medical, vision, dental, and life and disability insurance
Eligibility to enroll in company 401(k) plan

Additional Information:

Job Posted:

March 23, 2025

Employment Type:

Fulltime

Work Type:

On-site work

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