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 one thousand employees, and 40 years’ experience.
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!
We are currently looking for a Credentialing Specialist to join our HR Team!!
The Credentialing Specialist is responsible for providing credentialing to our medical staff and sites through the processing of applications and reapplications to ensure both qualified practitioners provide care within our facilities and that out sites are appropriately credentialed with our payors. Researches, monitors, organizes and maintains applicable documents/applications/status/information within internal system and appropriate outside entities. Maintains accurate, up-to-date provider/site data to include updates, changes, additions, renewals and terminations in credentialing, while working under required timelines. Performs credentialing and recredentialing activities including: processing applications, primary source verifications, communicating with providers to request missing information supporting the integrity of provider data in all systems, and entering initial data of potential network providers into the credentialing system. Obtains documents pertaining to licenses, follows accurate protocol for each entity in which staff/site(s) are credentialed through and track statuses of staff/site(s) until credentialed
Duties & Responsibilities:
- Performs provider credentialing/qualifying process to ensure all requirements are met in accordance with credentialing requirements prior to presentation to the RBHA, 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, XDEA (NADEAN/Suboxone Waiver) 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 SB&H 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
- Process and maintain credentialing and re-credentialing in accordance with client facility policy and procedure, CARF standards, State and Federal Regulatory regulations.
- Monitor collection of all information received; follow up on missing items and/or incomplete forms, submit follow up requests for verifications as needed.
- Monitor applications to ensure timely verification of credentialing and responses from multiple payors.
- Monitor and manage credentialing expirables. Includes Board Certifications, Licensing, DEA/XDEA expirables, etc.
- Identifies potential red flags and works in collaboration with practitioner to document the issue and healthcare provider response.
- Advise supervisor of questionable information received and any issues identified during the processes.
- Submit closed files for audit/final review and secure missing items
- Maintain credentialed files
- Update provider rosters based on agency requirement
- Work collaboratively within other departments to avoid billing issues.
- Oversee CAQH, NPI, NPDB profiles to ensure that provider information is kept current.
- Maintain high quality, timely and accurate licensing processes of healthcare agencies per SB&H 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.
- Responsible for site credentialing including creation of new site packages and monitoring credentialing dates.
- Partner with internal customers to obtain required forms for both provider and site credentialing. This includes, Certificates of Insurance, CARF, CLIA, etc.
- Provide feedback, process improvement and ideas to management concerning credentialing areas of concern or improvement.
- Ensure strict confidentiality at all times.
Education & Qualifications:
- High School Diploma/GED plus three years credentialing experience.
- Credentialing for providers with multiple payors Experience using Provider Credentialing software systems or Provider Data Management Systems preferred.
- Associates degree in health information management preferred.
- Certified Provider Credentialing Specialist preferred.