Credentialing Specialist

About Us
The Arizona Alliance of Community Health Centers (the Alliance) is the Primary Care Association (PCA) for Arizona. We’re a nonprofit member organization that represents Community Health Centers (CHCs); Arizona’s largest primary care network. CHCs deliver healthcare services that meet the needs of their communities, connecting people to quality care that gives everyone an equal opportunity to thrive. We facilitate that vital work by providing CHCs with training, technical assistance, programmatic support, and advocacy.

Why You Should Join Us
Here at the Alliance, we believe that our greatest asset in achieving our goals is providing our employees with the support, leadership, and resources they need to do their best work. We believe in work-life balance and the restorative power of rest, so we offer 12 paid holidays, 1 paid day off during birth month, 6 days of sick pay, 3 personal days, and 10 days of vacation pay per year. Vacation accrual increases by 5 days at the first, fifth, and eleventh-year anniversary date.

Job Purpose and Basic Function
The Credentialing Specialist is responsible for supporting the development of AACHC's centralized provider credentialing program and coordinating, maintaining, and monitoring credentialing, privileging, enrollment, and recredentialing processes for healthcare providers at participating Health Center Program Grantees and Look-Alikes.

1. Supports the development of AACHC’s credentialing program in alignment with project goals and objectives.
a) Researches credentialing requirements, processes, and resources needed to support development of credentialing program.
b) Leads the selection and implementation of a technology platform to support provider credentialing at participating Health Centers. Leads a cohort of participating Health Centers through program development and onboarding.
c) Collaborates with AACHC program staff to expand credentialing services to additional interested Health Centers.
d) Develops and maintains standardized credentialing workflows and procedures.
e) Collaborates with consultant, as appropriate, to develop program within AACHC.

2. Manages the credentialing, recredentialing, and privileging processes for healthcare providers at participating Health Centers.
a) Coordinates initial credentialing, recredentialing, and privileging activities for physicians, nurse practitioners, physician assistants, dentists, behavioral health providers, pharmacists, and other licensed practitioners.
b) Conducts primary source verification of provider licenses, DEA registrations, board certifications, education, training, work history, and applicable exclusion and disciplinary records.

c) Maintains accurate provider credential files in compliance with organizational policies and regulatory requirements.
d) Maintains and updates provider credentialing information within applicable systems.
e) Monitors provider credential expiration dates and coordinates timely renewals and recredentialing activities.
f) Facilitates credentialing committee reviews and maintains meeting documentation.

3. Manages provider enrollment processes with government and commercial payers on behalf of participating Health Centers.
a) Completes and submits provider enrollment applications for Medicare, Medicaid, managed care organizations, and commercial insurance plans
b) Monitors enrollment application status and follows up with payers regarding outstanding requirements.
c) Maintains accurate provider demographic information within payer systems.
d) Coordinates provider roster submissions and updates as required by health plans.

4. Monitors credentialing compliance requirements and supports regulatory compliance activities for participating Health Centers.
a) Supports compliance with applicable HRSA, CMS, NCQA, and state and federal credentialing requirements.
b) Conducts monthly exclusion screenings and maintains related documentation.
c) Supports internal and external audits by preparing credentialing documentation and reports.
d) Supports the development and maintenance of credentialing policies. procedures.
e) Monitors changes to credentialing regulations and requirements and communicates relevant updates to participating Health Centers.

General Development
1) Possesses at least 2 years of credentialing or provider enrollment experience within a healthcare organization.
2) Experience with Medicare, Medicaid, and managed care enrollment processes required.

Licenses & Certifications
1) Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM).

Knowledge, Skills, and Abilities

1) Strong knowledge of provider credentialing, recredentialing, and privileging processes.
2) Intermediate knowledge of Medicare, Medicaid, and commercial payer enrollment requirements.
3) Intermediate knowledge of HRSA, CMS, NCQA, and other applicable credentialing standards.
4) Intermediate knowledge of credentialing databases and provider enrollment systems, including CAQH, PECOS, and NPPES.
5) Ability to communicate effectively, both orally and in writing, with providers, Health Center staff, payers, and other stakeholders.
6) Ability to research, interpret, and apply credentialing requirements and procedures.
7) Ability to maintain accurate records and exercise discretion when handling confidential information.
8) Ability to manage multiple priorities, track deadlines, and maintain attention to detail.
9) Intermediate knowledge of Microsoft Office applications, including Word and Excel.
10) Ability to identify and resolve routine credentialing and enrollment issues.
11) Ability to coordinate activities and maintain effective working relationships with internal and external partners.

Telecommuting and Travel
This position is required to be on-site at least two days per work week.
Some travel may be required, including visits to Community Health Centers by vehicle or attendance at conferences via air travel, which may include weekends.

Physical Demands
AACHC is committed to creating a safe and inclusive work environment and will provide reasonable accommodations as necessary to perform the essential functions of the position. Work is performed in a climate-controlled office setting with extended periods of stationary work and frequent use of office technology requiring the ability to perform tasks using a computer, printer, and telephone. The employee is required to communicate information and ideas so others will understand. They must be able to exchange accurate information and interpret directions in a timely and correct manner. The employee is required to move about inside the office to access file cabinets, office machinery, and meeting spaces, and may occasionally need to travel outside of the office for business-related meetings and functions.