Search results

Credentialing Specialist - Phoenix

Credentialing

  • Posted: 09 January 2020
  • Full-time
  • Phoenix, AZ, USA

At American Vision Partners (AVP), we’re bringing the best together. Our company was created with the affiliation of Barnet Dulaney Perkins Eye Center, Southwestern Eye Center, and the M&M Eye Institute. Today we’re one of the nation’s largest and most comprehensive ophthalmology practices with more than 45 eye care centers in Arizona and New Mexico - including 24 ambulatory surgical centers. At AVP we are committed to best in class patient care, being a pioneer in research and technology and most importantly, rewarding and recognizing our employees!

Credentialing Specialist 
Phoenix (Biltmore) Office 

As a Credentialing Specialist, you'll directly manage the provider credentialing, privileging and licensing processes for state licensing, ASC and hospital credentialing and privileging as well as AAAHC accreditation. 

Responsibilities:

  • Coordinates and monitors the review of practitioner applications and documents, ensuring applicant eligibility
  • Responsible for provider privileging, initial and re-credentialing process for Medical Staff, and Allied Healthcare Professionals at hospitals
  • Ensures compliance with AAAHC, State and Medicare regulatory agencies
  • Keeps expiring credentials up-to-date and maintaining credentialing database
  • Primary Source Verification of all components of the application file
  • Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up
  • Prepares credentialing files for completion and approval of the Peer Review Committee, Medical Executive Committee, and ensuring files are complete and within their required time periods
  • Creates and maintaining individual provider credentials files
  • Responds to inquiries from other healthcare organizations, interfaces with internal staff and external providers
  • Creates and maintains Paperless Credentialing files
  • Responds to inquiries from other healthcare organizations, interfaces with internal staff and external providers
  • Assists with managed care credentialing
  • Utilizes credentialing databases, and credentialing files for optimal efficiency
  • Monitors the initial, reappointment for medical staff, Allied Health, and other health care professional staff ensuring compliance with State, Medicare and AAAHC
  • Maintains for internal credentialing ambulatory surgical centers and other facilities
  • Performs miscellaneous job related duties as assigned

Qualifications:

  • High school diploma or GED required
  • 4 -6 years' experience directly related to healthcare medical staff credentialing
  • Current Certified Provider Credentialing Specialist (CPCS) with the National Association of Medical Staff Services preferred
  • Knowledge of general credentialing policies & procedures, managed care credentialing & NCQA Standards, and medical credentialing & privileging procedures & Standards
  • Knowledgeable and familiar with NPDB and AMA
  • Experience with Credentialing Data Base (ECHO)
  • Database management skills including querying, reporting & document generation
  • Computer background (Word, Excel, Adobe & Microsoft Outlook)
  • Detailed oriented, reliable and able to multi-task in a fast-paced, high-volume work environment
  • Excellent verbal and written communication skills
  • Ability to use independent judgment to manage confidential information

Benefits & Perks:

Your health, happiness and your future matters! At AVP, we offer everything from medical and dental to significant eye care discounts, continuing education, 401(k), 9 paid holidays plus PTO, flexible work hours and much more!

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.