Job Description

Job Category:
Administrative Position

Title:
Credentialing Specialist

Location:
AZ-Phoenix-Administration Building

Join Southwest Behavioral & Health for exceptional growth opportunities driven by our promote-from-within philosophy. We provide an EXCELLENT compensation and benefits package, including immediate participation in our 403(b) program with 20% company match after 1 year of service. Generous Paid Time Off (PTO) includes 3 weeks of time-off your 1st year (available after 6 months) and increased vacation accruals after 2, 5 and 10 years of service! We offer low cost medical insurance and offer 100% company-paid dental, Short Term Disability, Long Term Disability, and Life coverage for employees. Other great benefits include 10 paid holidays, vision, licensure/certification reimbursement, tuition reimbursement, prescription drug discounts, chiropractic services, 100% paid Employee Assistance Program, and much more!

Southwest Behavioral & Health Services is a large and growing, non-profit community-based provider of behavioral health services with locations throughout the Phoenix metropolitan area, rural Maricopa County, Gila, Pinal, Mohave, Coconino, and Yavapai Counties. We are a well-established voice in the community with more than 115 sites, over seven hundred employees, and 40 years’ experience.

We are seeking a Credential Specialist to join our Human Resources department! The position will be working Monday through Friday.

The Credentialing Specialist is responsible for providing credentialing to our Medical Staff through the processing of applications and reapplications to ensure that only qualified practitioners provide care within our facilities. Maintains accurate, up-to-date provider data to include updates, changes, additions, renewals and terminations in credentialing, while working under required timelines. 

Responsibilities: 

  • Performs provider credentialing/qualifying process to ensure all requirements are met in accordance with credentialing requirements prior to presentation to the RBHA’s, Medicare, AHCCCS, and various entities.
  • Notify and assist providers in renewing expiring credentials such as licensure, RBHA’s, Medicare, AHCCS,  and various entities, as required by contract while ensuring that all credentials are current at all times.
  • Ensure that all credentials files are current and complete pursuant to expiration date of medical licenses, board certification, professional-liability insurance coverage, DEA and other pertinent information, per SBH and/or client facility policy and procedures.
  • Maintain high quality, timely and accurate credentialing processes of healthcare providers per SBH policy and procedure.
  • Assist in the credentialing process by entering/logging/scanning information into credentialing system for initial, updating, and add on applications and maintenance processes.
  • Acts as liaison with RBHA’s as point person for completing and ensuring compliance and delivery of required information to providers in a timely manner.
  • Process and maintain credentialing and re-credentialing in accordance with client facility policy and procedure, carf standards, State and Federal Regulatory regulations. This will include but not limited to the following verifications:
  • Monitor collection of all information received; follow up on missing items and/or incomplete forms, submit follow up requests for verifications as needed.
  • Identifies and evaluates potential red flags and works in collaboration with practitioner to document the issue and healthcare provider response.
  • Advise Manager and/or Regional Director of questionable information received and any issues identified during the processes.
  • Submit closed files for Manager audit/final review and secure missing items as identified by SBH audit/final review process.
  • Maintain all credentials files ensuring that all correspondence in the credentialing and reappointment process is accurately filed; is knowledgeable and current on the process and legal/regulatory requirements.
  • Updates Provider Roster for Commercial Agencies on an as needed basis. 
  • Work collaboratively within other SBH departments to ensure that provider and/or RHBA relationships are up to date to avoid billing issues. 
  • Oversee CAQH, NPI, NPDB profiles to ensure that SBH provider information is kept current.
  • Acts as liaison with RBHA’s and other regulatory agencies as point person for completing and ensuring compliance and delivery of required information in a timely manner.
  • Maintain high quality, timely and accurate licensing processes of healthcare agencies per SBH policy and procedure.
  • Responsible for completing monthly reporting:  This includes, but not limited to Steward Health Choice, Cenpatico, Mercy Care, AHCCCS and other regulatory agencies.

Requirements:

  • High School Diploma/GED plus two years related experience. Credentialing experience preferred. Experience preferred using Provider Credentialing software systems or Provider Data Management Systems.
  • Ability to process computer data and to format and generate reports.
  • Skills in database management.
  • Skill in planning, organizing and coordinating activities related to assigned work.
  • Knowledge of ADHS training requirements and related R-9 10 Licensure regulations.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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