Credentialing Specialist

Summary/Position Objectives:
Responsible for performing and/or coordinating all activities associated with credentialing or recredentialing practitioners in accordance with NCQA and SCHN standards and policies within prescribed time frames.

Responsibilities:
Essential Functions
Coordinates all phases of credentialing activities for potential practitioners. Follows established procedures to ensure a comprehensive review of professional credentials.
Assist in the training of other credentialing specialists.
Maintains electronic practitioner files and credentialing documentation in a form that meets or exceeds National Committee for Quality Assurance (NCQA), Arizona Health Care Cost Containment System (AHCCCS) and Southwest Catholic Health Network (SCHN) standards.
Reviews credentialing files to maintain confidentiality and to facilitate timely completion of the credentialing process.
Initiates and queries the National Practitioner Data Bank (NPDB).
Responds to practitioners regarding status of applications and status of credentialing process. Updates provider representatives regarding completed credentialing.
Assist with and participates in the recredentialing process each month. Maintains electronic files to facilitate this activity.
Initiates and tracks correspondence to complete delinquent initial and recredentialing files.
Maintains credential database through ongoing data entry of practitioner updates with accuracy and in compliance of established integrity guidelines.
Collects, reviews, and documents performance data to include QI activities, UM profiles, and member complaint data for recredentialing purposes.
Assists in the preparation of the monthly Credentialing Committee meetings including post-committee procedures. Assists with meeting arrangements and notifications.
May assist with audits of delegated subcontractors for adherence to NCQA, AHCCCS & SCHN credentialing and recredentialing procedures.
Works in a manner that is not disruptive to peers, supervisors and subordinates.
Performs other duties, assignments and responsibilities as assigned or required.

Secondary Functions:
Works in a manner that is not disruptive to peers, supervisors and/or subordinates.
Must maintain regular and acceptable attendance at such level as is determined in the employer’s sole discretion.
Must be available and willing to work such days and hours as the employer determines are necessary or desirable to meet its business needs.
Must be available and willing to travel to such locations and with such frequency as the employer determines is necessary or desirable to meet its business needs. (If travel required.)
REQUIREMENTS
Knowledge and Skills:
Percentages, ratios, multiplication, division, addition, subtraction. Strong analytical capability. Moderate choice of action - requires full understanding of basic fundamentals in order to proceed. Ability to handle multiple projects simultaneously. Must be able to read, write and orally communicate at a level to sufficiently and correctly define and explain a moderately complex logical problem. Familiar with Windows environment and proficient in Microsoft Access, Microsoft Word, & Microsoft Excel ; PC, typing of 55 wpm required; copy machine; fax.

Education and Work Experience:
High School Diploma or equivalent. Proficiency in word processing, spreadsheet and database applications.
One year of experience directly involved in the processing of credential files.

Schaller Anderson team members are provided with countless opportunities to make a real difference and the following compensation/benefits:

* Competitive compensation DOE
* Medical, Dental and Vision insurance
* Employee Assistance Program
* Flexible spending accounts
* On-site fitness center (Phoenix headquarters only)
* Life insurance and accidental death and dismemberment insurance
* Short-term and long-term disability
* Paid holidays, paid time off/paid time off reserve
* 401(k)
* Tuition reimbursement
Visit www.schalleranderson.com for more information or submit a resume to [Click here for email]. EOE