CREDENTIALING ADMINISTRATOR

Job Details Job Location: Scottsdale Office - Scottsdale, AZ 85255 Position Type: Full Time Education Level: High School Travel Percentage: None Job Shift: Day Job Category: Admin - Clerical About the Role Affiliated Dermatology is looking for a detail-oriented, resourceful Credentialing Administratorto join our administrative team. This role supports the credentialing, enrollment, and payer-related processes that allow our providers to care for patients across our Arizona practices. This is a great opportunity for someone who understands the healthcare insurance world and enjoys figuring out how all the pieces fit together. While direct credentialing experience is valuable, we are particularly interested in candidates with experience in payer contracting, provider relations, health plan operations, provider enrollment, or healthcare revenue cycle functionswho are interested in expanding their knowledge of credentialing. You’ll work closely with another experienced Credentialing Administrator and interact regularly with providers, health plans, payer representatives, and internal teams. Success in this role requires strong follow-through, attention to detail, and the confidence to research, question, and resolve payer issues when the answer isn't always straightforward. What You'll Do Coordinate credentialing and recredentialing for physicians and advanced practice providers. Maintain accurate and complete credentialing records for new and existing providers. Manage provider enrollment, additions, terminations, demographic changes, and other updates with assigned health plans. Verify and maintain required provider credentials, including state licensure, board certification, DEA registration, education, and other applicable documentation. Work with commercial, Medicare, Medicaid/AHCCCS, and other health plans to complete enrollment and maintenance activities. Navigate payer portals and other credentialing systems to submit applications, monitor status, research requirements, and resolve outstanding issues. Maintain and update provider information within systems such as CAQH and other credentialing platforms. Develop strong working relationships with payer and provider representatives and know when and how to elevate an issue. Research discrepancies, conflicting information, enrollment issues, and payer requirements and follow them through to resolution. Monitor deadlines, recredentialing requirements, revalidations, and outstanding payer requests. Participate in payer/provider forums and stay informed of changes to health plan requirements and processes. Support EFT and ERA enrollment or related payer administrative functions as assigned. Maintain clear documentation of payer processes, contacts, requirements, and workflow changes. Partner with the Credentialing team to provide cross-coverage and ensure continuity during vacations, absences, or high-volume periods. Communicate professionally with providers, medical staff, health plans, and other internal and external partners. Maintain confidentiality and follow HIPAA, organizational, and applicable regulatory requirements. Qualifications What We're Looking For We're less concerned with finding someone who has worked every plan we work with and more interested in finding someone who understands healthcare payers, knows how to research a problem, and doesn't get intimidated when the process gets complicated. Preferred experience includes: Payer contracting, provider contracting, provider relations, provider enrollment, healthcare credentialing, or health plan operations Working directly with commercial insurance plans, Medicare and/or Medicaid managed care Understanding payer contracts, provider participation, network enrollment, or claims/denial issues Navigating payer portals and multiple healthcare information systems Working with CAQH or similar credentialing systems Supporting physicians or advanced practice providers in a medical practice or healthcare organization Credentialing experience is preferred but not required for a candidate with strong payer, contracting, or healthcare insurance experience and the ability to learn credentialing processes. You’ll Be Successful Here If You Are Highly organized. There are multiple providers, plans, deadlines, applications, and follow-ups moving at the same time. Persistent. You don't assume an issue is resolved simply because an email was sent. A strong problem-solver. When a payer gives you conflicting information, you're comfortable researching the answer and determining the appropriate next step. Detail-oriented. Small errors in provider information can create much bigger problems downstream. Comfortable working independently. You can manage your responsibilities without needing constant direction. Collaborative. You'll have primary responsibility for assigned health plans while also learning enough about your teammate's plans to provide effective backup coverage. Adaptable. Payer requirements change. Sometimes frequently. You are comfortable learning, documenting, and adjusting when they do. A clear communicator. You're equally comfortable working with a physician, internal team member, payer representative, or health plan contact. Work Structure This position will initially workonsite at our North Scottsdale office for approximately the first 90 days to allow for hands-on training, workflow development, and integration with the Credentialing team. Following successful completion of the initial training period and demonstration of the ability to work independently, the position may transition to a remote work arrangement consistent with department expectations. Why This Role Matters Credentialing is one of those functions that works best when no one notices it because providers are enrolled correctly, deadlines are met, information is accurate, and problems are resolved before they affect patient care or reimbursement. You’ll join a small, experienced team where you will have ownership of your work while also building enough shared knowledge to ensure the department isn't dependent on any one person. We value documentation, cross-training, collaboration, and continuous improvement, and we're looking for someone who wants to become a trusted resource in the organization. #J-18808-Ljbffr Affiliated Dermatology