CommonSpirit Health
Job Summary
Coordinates credentialing activities, including data entry and physician database maintenance, reappointment credentialing, expirables, and other duties supporting provider onboarding.
Key Responsibilities
Maintain up-to-date physician database of applications and enrollment status.
Ensure accuracy and integrity of data entered into the credentialing database system.
Assist in designing and compiling data supporting internal statistical monitoring.
Continuously collect information required to comply with delegated agreements and credentialing policies.
Conduct credentialing database training for new hires and refresher training for existing staff; provide input for training materials and job aids.
Review applications and other data sources for accuracy and completeness prior to submission to Health Plan.
Liaise with Health Plan representatives regarding credentialing applications, audits, provider load confirmation, fee schedule issues, and corrective action plans.
Maintain relationships with office personnel, Legal, Regulatory, and Health Plan's Provider Relations departments to ensure timely completion of the delegated credentialing process.
Qualifications
High School Diploma or GED.
At least 3 years of experience in a health care plan credentialing, provider relations, audit setting, or health care enrollment.
Preferred Qualifications
Bachelor’s degree.
Certified Professional Medical Services Management (CPMSM) and/or Certified Provider Credentialing Specialist (CPCS) certification.
Knowledge, Skills & Training
Proficient with CACTUS software or similar credentialing systems; intermediate Microsoft Office skills.
Knowledge of NCQA and Joint Commission standards.
Understanding of common practices and procedures in physician credentialing.
Location Phoenix, AZ
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Key Responsibilities
Maintain up-to-date physician database of applications and enrollment status.
Ensure accuracy and integrity of data entered into the credentialing database system.
Assist in designing and compiling data supporting internal statistical monitoring.
Continuously collect information required to comply with delegated agreements and credentialing policies.
Conduct credentialing database training for new hires and refresher training for existing staff; provide input for training materials and job aids.
Review applications and other data sources for accuracy and completeness prior to submission to Health Plan.
Liaise with Health Plan representatives regarding credentialing applications, audits, provider load confirmation, fee schedule issues, and corrective action plans.
Maintain relationships with office personnel, Legal, Regulatory, and Health Plan's Provider Relations departments to ensure timely completion of the delegated credentialing process.
Qualifications
High School Diploma or GED.
At least 3 years of experience in a health care plan credentialing, provider relations, audit setting, or health care enrollment.
Preferred Qualifications
Bachelor’s degree.
Certified Professional Medical Services Management (CPMSM) and/or Certified Provider Credentialing Specialist (CPCS) certification.
Knowledge, Skills & Training
Proficient with CACTUS software or similar credentialing systems; intermediate Microsoft Office skills.
Knowledge of NCQA and Joint Commission standards.
Understanding of common practices and procedures in physician credentialing.
Location Phoenix, AZ
#J-18808-Ljbffr