Credentialing Specialist - Tucson and Phoenix, AZ (Corporate-Bonita)

Looking to build a lasting career? Join a team that is inclusive and embraces all individuals. Intermountain Centers is one of the largest statewide behavioral health and integrated care organizations in Arizona. What does building a lasting career look like? Top-level compensation packages Exceptional health, dental, and disability benefits Career and compensation advancement programs Student loan forgiveness programs 401k company match Bilingual pay differential Holiday, PTO and employer paid life insurance Clinical licensure supervision and reimbursement Evidence-based treatment approaches, training, and supervision. Intermountain Centers and its statewide affiliates are currently recruiting career‑minded individuals interested in opportunities within the largest adult and child service continuum in Arizona. General Summary Responsible for initiating, coordinating, monitoring, and managing credentialing processes with contracted health plans. Facilitates all aspects of practitioner, organizational and facility credentialing, in accordance with state, federal and health plan requirements. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statutes and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing software system and management of related applications. Job Responsibilities Ensure licensed independent practitioners, medical providers, therapeutic foster families, and site locations meet credentialing requirements as set forth by each contracted health plan, including AHCCCS, commercial and Medicare health plans. Collaborate with program manager and HR to compile and submit credentialing documents and applications necessary to implement the credentialing process. Perform initial review of credentialing documents to ensure practitioner is in good standing with CAQH, AHCCCS and licensing board(s). Identify issues/discrepancies that require additional review and follow‑up. Complete requests and/or updates for Medicare, AHCCCS IDs, CAQH, NPI and other steps needed for the credentialing process. Perform re‑credentialing activities upon request and within time frames specified by the health plan. Manage and maintain credentialing files and/or profiles as needed to ensure provider information is accurate and up to date. Track and monitor provider credentialing/re‑credentialing applications from submission to completion. Maintain credentialing software with current provider and site information. Respond to inquiries from healthcare organizations, interface with internal and external customers as needed. Create and distribute credentialing status reports on a regular basis. Perform reconciliation and maintenance activities of health plan directories/rosters as required by health plan. Conduct on‑going credentialing audits; conduct internal file audits. Perform query, report and document generation; submit and retrieve National Practitioner Database reports in accordance with the Health Care Quality Improvement Act. Manage the initial, reappointment and expirable process for all Behavioral Health Medical Professionals and independently licensed professional staff, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state), as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures, and delegated contracts. Follow all policies, procedures, and controls established by the organization, the HIPAA Privacy Officer, and/or the HIPAA Security Officer regarding access to, protection of, and use of PHI. Qualifications High School Diploma or GED required. At least 3 (three) years of experience in a health care environment performing provider enrollment, credentialing and/or some contracting tasks, preferably with a behavioral health agency or health plan. Completed degree(s) from an accredited institution above the minimum education requirement may be substituted for experience on a year‑for‑year basis. Intermountain Centers is an equal opportunity employer. Intermountain Centers does not discriminate based on age, ethnicity, race, sex, gender, religion, national origin, creed, tribal affiliation, ancestry, gender identity, sexual orientation, marital status, genetic information, veteran status, socio‑economic status, claims experience, medical history, physical or intellectual disability, ability to pay, source of payment, mental illness, and/or cultural and linguistic needs, as well as any other class protected by law. #J-18808-Ljbffr