Job Description

HYBRID: 3 days in the office at Sierra Tucson, 2 days remote SCHEDULE: Monday - Friday, hours are flexible PURPOSE STATEMENT: The primary duty of the Credentialing Specialist is to manage the credentialing portion of the internal credentialing and provider enrollment process for individual providers/clinicians. They will partner with facilities, providers/clinicians, and field leadership to prepare the proper documentation for initial and re-credentialing application submissions to meet required deadlines, assist in the completion of Medicaid enrollments, and will be responsible for completing enrollment for any other payors as needed. The Credentialing Coordinator maintains the department workflow to ensure accuracy and completion of tasks in a timely manner. ESSENTIAL FUNCTIONS: Request and review key credentialing file documentation for each provider/clinician. Review and complete Primary Source Verification for all vital credentialing file documentation. Prepare and submit initial and re-credentialing documentation for each payor as needed. Track and monitor incoming and outgoing credentialing requests, including maintenance of credentialing files. Maintain various database systems. Prepare and submit state Medicaid and other payor enrollments and re-validations. Work directly with payers, the CBOs, and Contracting Departments to resolve disputes. Prepare and administer routine correspondence, memoranda, and notifications. Work closely with the CBOs and Contracting Departments to ensure efficiency of processes and create new workflow tools as needed. Update and maintain in-house documents. OTHER FUNCTIONS: Performs other duties as assigned. STANDARD EXPECTATIONS: Complies with organizational policies, procedures, performance improvement initiatives and maintains organizational and industry policies regarding confidentiality. Communicate clearly and effectively to person(s) receiving services and their family members, guests and other members of the health care team. Develops constructive and cooperative working relationships with others and maintains them over time. Encourages and builds mutual trust, respect and cooperation among team members. Maintains regular and predictable attendance. EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: BA/BS degree preferred. 1 - 3 years of healthcare related experience required. 1 - 3 years healthcare credentialing experience preferred. Basic to working knowledge of contracting concepts. Must be proficient in Microsoft Word and Excel. Documentation, proficiency, attention to detail, and organization skills are essential. Ability to multi-task is a must LICENSES/DESIGNATIONS/CERTIFICATIONS: Not Applicable SUPERVISORY REQUIREMENTS : This position is an Individual Contributor While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances (e.g. emergencies, changes in workload, rush jobs or technological developments) dictate. We are committed to providing equalemployment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws. STU01 #LI-ST #J-18808-Ljbffr

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