Internal Credentialing Specialist

Terros Health
Published
December 2, 2020
Location
Phoenix, AZ
Job Type
Category

Description

 

 

Terros Health is pleased to share an exciting and rewarding opportunity for an Internal Credentialing Specialist working at our Central Avenue Location (possibility for remote work in Arizona is an option).  Reporting to the Director of Payer Relations, the ideal individual is flexible, compassionate, and professional.  If you enjoy working with individuals during some of the most vulnerable times of their lives this may be just the opportunity you have been seeking.

We are a healthcare company focused on the whole person, providing primary care, and specializing in mental health and substance use treatment for the last 50 years.

We help people live their lives in recovery and we save lives every day.

Our role provides foundational support to our company’s work. It starts with contracts which we’ve been awarded, our staff credentialing the providers and ensuring that all our sites are licensed so that they may treat patients. Along with great benefits, continuous training, and a welcoming environment, we offer the opportunity for you to grow in your career with Terros Health.

Terros Health is a healthcare organization of caring people, guided by our core values of integrity, compassion and empowerment. For more than four decades, the heart of everything we do is inspiring change for life. We help people manage addiction and mental illness, provide primary medical care, restore families, support our veterans, and connect individuals to the care they need.

Location - Phoenix, AZ (Central Avenue Administration Office, ability to work remote)

Main Duties:

  • Leads, coordinates, and monitors the INTERNAL credentialing and privileging processes of obtaining, verifying, and assessing the credentials of all licensed and certified practitioners.
  • Conducts thorough background investigation using online systems of NPDB, OIG and appropriate state licensing boards for obtaining real-time primary source verification of practitioner credentials.
  • Identifies issues that require additional investigation and evaluation; validates discrepancies and ensures appropriate follow-up.
  • Completes and submits monthly credentialing reports for credentialing committee approval, and quarterly reports for review by Terros Health Board of Directors.
  • Corresponds directly with practitioners, department heads and management staff as needed regarding credentialing status and issues.
  • Executes credentialing duties in accordance with HRSA FQHC regulations and CARF accreditation.

Education – Bachelor’s Degree preferred.

Experience/Qualifications:

  • Bachelor’s Degree preferred and at least two years’ experience in credentialing preferably in an integrated managed care environment.
  • Knowledge of basic requirements for contracting, insurance, and credentialing for integrated health services, clinical operations.
  • Knowledge of general rules and regulations governing federally funded clinical programs.  Care related to  Utilization review/quality assurance principles and terminology.
  • Possess excellent analytical skills.
  • Ability to process electronic reports.
  • Proficient in Word and Excel.

Knowledge, Skills and Abilities Required

  • Ability to communicate effectively, both orally and in writing.
  • Informational research skills.
  • Database management skills including querying, reporting, and document generation.
  • Ability to make administrative and procedural decisions and judgments.
  • Ability to communicate and work effectively with professionals at all levels.
  • Must have valid Arizona driver’s license, be 22 years of age with minimum 3 years driving experience and meet requirements of Terros Health’s driving policy.
  • Must have a valid Arizona Fingerprint Clearance card or apply for an Arizona fingerprint clearance card (Level 1) within 7 working days of assuming role.
  • Must pass a TB Test.
  • Physical demands of this position are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Link to website - https://www.terroshealth.org/careers/

Apply via the website: https://www.terroshealth.org/careers/

 

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