Credentialing Coordinator

Our Mission:  Provide the best value in health insurance and related health services to improve the quality of life for Arizonans.

Position Purpose: Reporting to the Credentialing Manager, the Credentialing Coordinator facilitates the accurate and efficient Credentialing and Recredentialing of Health Choice providers in alignment with State, Federal, and NCQA standards.

Responsibilities:

• Ensure timely and accurate processing of credentialing and recredentialing for both individual practitioners and organizations
• Coordinate Credentialing Committee meeting, including preparing the agenda and documenting meeting minutes
• Identify and communicate agenda items for Credentialing Committee to the Credentialing Manager
• Facilitate prompt coordination with the Credentialing Verification Organization (CVO) and monitor Work in Progress file
• Promptly address incoming files for processing
• Review and maintain all applications for accuracy and completeness
• Accurately and efficiently data enter primary source verification data into the credentialing database
• Input credentialing decisions and dates into the credentialing database
• Generate and mail approval letters to participating providers
• Identify missing or erroneous information from the provider’s application, and communicate with the provider to obtain
• Coordinate with Network Services and/or other internal departments on follow-up items needed to complete the credentialing process
• Communicate with Network Services and/or other internal departments regarding status of provider and organizational credentialing
• Maintain ongoing participation in cross-training activities
• Provide recommendations and feedback regarding process improvements and/or standardization practices
• Actively participate in staff meetings, team huddles, and one-on-one meetings
• Engage in team building activities
• Other duties as assigned

Education / Experience / Other Requirements

Education:

• Associates degree in a related field (or equivalent combination of education and experience)

Years of Experience:

• A minimum of two years of relevant work experience in a healthcare field, preferably within a credentialing/recredentialing environment and knowledge of national accreditation and/or regulatory standards

Specialized Knowledge:

• Thorough understanding of managed care principles and physician practice operations, with an understanding of health plan credentialing preferred
• Certified Provider Credentialing Specialist (CPCS) preferred

Skills & Abilities:

• Ability to think critically
• Strong attention to detail
• Excellent organizational skills
• Verbal and written communication skills
• Outstanding interpersonal skills, ability to establish a trusting rapport with individuals at all levels
• Maintains confidentiality according to policy

• Effectively communicate with internal and external customers via telephone and email

• Accurately receive information through oral communication
• Accurately review data and figures both in hard copy and electronic formats
• Utilize a computer (including but not limited to a mouse and keyboard) and telephone intermittently throughout entire shift, for periods of up to four (4) hours at a time
• Accurately sort through data and think through issues in a timepressured environment
• Focus on a specific event or activity for up to four (4) hours at a time without interruption
• Maintain a calm and collected presence while addressing the concerns from an internal and external customer
• Accurately learn and retain new information, knowledge and skills
• Efficiently manage multiple tasks, with varying degrees of priority, at the same time