Credentialing Specialist

About the role

We provide excellent, compassionate care to our patients, their families, and visitors. The Credentialing Specialist performs essential Medicare, AHCCCS, and commercial payor credentialing functions, reporting to the Credentialing Supervisor and collaborating with Operations Leaders to ensure accurate and efficient provider onboarding and timely re-credentialing.

Responsibilities

• Process credentialing and recredentialing applications for medical providers and organization.
• Prepare weekly reports for division administrators and providers.
• Follow OrthoArizona, federal, and state credentialing requirements.
• Assist with routine audits to ensure reimbursement aligns with current contracting and market rates.
• Prioritize work to ensure completion within required deadlines.
• Submit required documents on schedule and follow up as needed.
• Promote a positive attitude, teamwork, and fun in the workplace.
• Work independently and multitask effectively.
• Communicate and collaborate with employees, providers, and health plans.
• Maintain strict confidentiality of information and files.
• Demonstrate working knowledge of NPI and CAQH, including creating, updating, and maintaining profiles.
• Process DME applications, including CEDI and EFT enrollment.
• Create payor rosters.
• Maintain providers’ expirables, including address updates with DEA.
• Perform monthly sanction, debarment, and exclusion checks (SAM, OIG, OFAC, state licensing).
• Perform all other duties as assigned.

Qualifications

• Strong working knowledge of Medicare and commercial payor credentialing standards, PECOS, and AHCCCS.
• High proficiency with MS Office (Word, Excel, PowerPoint, Outlook).
• High School Diploma or equivalent.
• Experience in provider enrollment and credentialing for physicians and mid-level practitioners.
• Minimum of 3 years of Medicare, AHCCCS, and commercial payor credentialing experience.
• Knowledge of credentialing software and NCQA credentialing requirements.