Phoenix, AZ, 85067, USA
3 days ago
Credentialing Specialist
Description We are in search of a Credentialing Specialist to join our team based in Phoenix, Arizona. As a Credentialing Specialist, you will be pivotal in managing all facets of provider credentialing, re-credentialing and payer enrolment within a healthcare setting. This role offers a contract to permanent employment opportunity in the healthcare industry. Responsibilities: • Oversee the credentialing process for new providers, including the collection and verification of necessary documentation. • Prepare and submit credentialing applications to various healthcare organizations, insurance companies, and hospitals. • Monitor and manage the status of applications, and liaise with appropriate parties to resolve any issues or request additional information. • Handle the re-credentialing process for existing providers, ensuring timely submission and compliance with all rules and requirements. • Coordinate provider enrolment with different insurance payers, including commercial, Medicare, and Medicaid. • Maintain accurate records of all payer contracts and provider enrolments. • Review and interpret payer contracts, ensuring all terms and conditions are understood and followed. • Ensure adherence to all federal, state, and payer-specific regulations and requirements. • Maintain meticulous documentation of all credentialing and enrolment activities. • Conduct regular audits of credentialing files to ensure accuracy and completeness. • Act as the primary contact for providers, payers, and internal staff regarding credentialing and enrolment issues. • Collaborate with clinical and administrative staff to gather required documentation and information. • Provide training and guidance to staff on processes and policies related to credentialing. • Generate reports on credentialing and payer enrolment activities as per management's requirements. • Analyze trends and identify areas that need improvement in the credentialing process. Requirements • Proficiency in Customer Relationship Management (CRM) software • Demonstrable experience in auditing processes and documentation • Strong understanding of compliance regulations in the healthcare industry • Familiarity with the Council for Affordable Quality Healthcare (CAQH) procedures • Proven experience in credentialing, preferably within the healthcare sector • Proficient in managing and executing credentialing processes TalentMatch® Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles. Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more. All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information. © 2025 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https://www.roberthalf.com/us/en/terms) .
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