CREDENTIALING ADMINISTRATOR
On-siteScottsdale, Arizona, United States
Job Summary
Coordinate credentialing and recredentialing for physicians and advanced practice providers while maintaining accurate records and verifying state licensure, board certification, and DEA registration. Manage provider enrollment, additions, terminations, and demographic updates with commercial, Medicare, Medicaid, and other health plans by navigating payer portals and resolving outstanding issues. Maintain provider information within systems such as CAQH and support EFT and ERA enrollment as assigned. Monitor deadlines, recredentialing requirements, and revalidations while documenting payer processes and workflow changes. Work closely with providers, health plans, and internal teams to research discrepancies and escalate issues when necessary. This role requires strong follow-through and attention to detail in a fast-paced environment. You will initially work onsite at the North Scottsdale office for approximately 90 days before potentially transitioning to a remote arrangement.
Required Qualifications
- Strong follow-through
- Attention to detail
- Confidence to research, question, and resolve payer issues
- Highly organized
- Persistent
- Strong problem-solver
- Detail-oriented
- Comfortable working independently
- Collaborative
- Adaptable
- A clear communicator
Desired Qualifications
- Experience in payer contracting
- Experience in provider contracting
- Experience in provider relations
- Experience in provider enrollment
- Experience in healthcare credentialing
- Experience in health plan operations
- Experience working directly with commercial insurance plans
- Experience with Medicare
- Experience with Medicaid managed care
- Understanding of payer contracts
- Understanding of provider participation
- Understanding of network enrollment
- Understanding of claims/denial issues
- Experience navigating payer portals
- Experience with multiple healthcare information systems
- Experience working with CAQH
- Experience with similar credentialing systems
- Experience supporting physicians or advanced practice providers in a medical practice or healthcare organization
- Credentialing experience
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