Marana Health is seeking a Credentialing Specialist to join the Compliance team at the Marana Main Health Center, located in the heart of Marana, AZ.
The Credentialing Specialist oversees clinician credentialing, recredentialing, privileging, and third-party enrollment processes, ensuring timely completion, data integrity, and compliance with organizational, payer, regulatory, and accreditation standards.
Marana Health is a Federally Qualified Community Health Center (FQHC), with 11 sites in Tucson and Pima County. Our mission is to improve our community by providing exceptional, whole-person healthcare.
The following qualifications are required:
High school diploma or equivalent
2 years’ experience in clerical or administrative support
Fingerprint Clearance Card through the Arizona Department of Public Safety (or ability to obtain upon hire)
The following qualifications are preferred:
1 year experience in credentialing or related field
Certified Provider Credentialing Specialist (CPCS)
Equivalent combination of education and experience may be considered if applicable and must be directly related to the functions and body of knowledge required to successfully perform the job.
This position has the following supervisory responsibilities:
Does not direct or supervise others.
The ideal candidate will also possess the following knowledge, skills, and abilities:
Working knowledge of National Committee for Quality Assurance (NCQA) accreditation standards.
Ability to effectively collaborate within a team or work independently to accomplish tasks.
Demonstrated problem-solving skills.
Ability to effectively multi-task.
Computer proficient with Microsoft Office applications.
Ability to interpret organizational policy and procedure and apply it to assigned tasks.
Excellent customer service, organizational, and communication skills with emphasis on responsiveness, building trust, mutual respect, and courtesy.
Demonstrates professionalism, respect, and the ability to work effectively with individuals from diverse backgrounds, experiences, and perspectives.
Duties and Responsibilities:
Creates and maintains accurate and complete credentialing files for all clinicians following established requirements and procedures.
Obtains all necessary credentialing and recredentialing documents.
Conducts primary source verification of education, licensure, DEA registration, board certification, work history, sanctions, and references.
Submits credentialing files to for leadership review and Clinical Review Committee for determination of credentialing and privileging.
Notifies clinicians of final credentialing and privileging decisions.
Completes enrollment process for each new clinician with each participating health plan including Medicare, Arizona Health Care Cost Containment System (AHCCCS) and private plans.
Maintains contact information and working relationships with each participating health plan.
Updates health plans with additions, terminations, and changes of clinicians and locations, as required.
Completes delegation reports and updates clinician rosters for insurance providers as required.
Completes credentialing and re-credentialing for non-clinician roles in accordance with organizational policy.
Maintains compliance with Council for Affordable Quality Healthcare (CAQH) re-attestation and directory requirements.
Contacts each plan on a timely basis for any pending applications to check status and monitors progress to ensure timely completion.
Manages re-credentialing schedule and submits re-credentialing applications as they become due for processing.
Requests and maintains updated information from the clinicians including CVs, CMEs, and clinician demographic information.
Reports credentialing status to the appropriate organizational stakeholders to ensure awareness of credentialing statuses of clinicians.
Leads facility credentialing and recredentialing process as needed, ensuring credentialing with CMS entities and health plans.
Assists with departmental auditing.
Performs other duties as assigned.
Benefits:
Marana Health’s vision is to be the premier provider and employer in community health. To support our mission and vision in our community, Marana Health believes health and well-being must start at home. Therefore, employees have many opportunities to care for our own health and wellness with benefits such as:
Medical, Dental, and Vision
403(b) with employer contribution
Short-term disability and other benefits
Paid time off including 11 holidays plus vacation and sick leave accrual
Paid bereavement, jury duty, and community service time
Education reimbursement ($3,000 per year for full-time)
Marana Health is committed to providing equal employment opportunities to all individuals, including those with disabilities and pregnancy-related conditions. If you require a reasonable accommodation to apply for a position or to participate in the interview process under the Americans with Disabilities Act (ADA) or the Pregnant Workers Fairness Act (PWFA), please contact our Human Resources Department at 520-682-4111.
