• Contracts and Credentialing Specialists

    Job Locations US-AZ-Tucson
    Job ID
    Regular Full-Time
    Mental and Behavior Health
  • Overview

    Position Overview

    Responsible for initiating, coordinating, monitoring, and maintaining enterprise-wide contracts and credentialing processes with health plans/funders. Facilitates all aspects of Intermountain Centers practitioner credentialing, in accordance with state, federal and health plan/funder requirements, , policies and/or procedures. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database system and related applications.




    Job Responsibilities:




    • Ensures licensed independent practitioners and medical providers meet credentialing requirements as set forth by each contracting health plan, including AHCCCS health plans and Medicare.
    • Collaborates with clinical staff to draft, compile and submit all necessary credentialing documents necessary to implement the credentialing process; obtains provider signatures, certificates of insurance, DEA#s, etc.,
    • Performs initial review of credentialing documents to ensure practitioner is in good-standing with regulatory agencies.
    • Identifies issues/discrepancies that require additional review and follow-up.
    • Completes requests for Medicare, AHCCCS IDs, CAQH, NPI and other steps needed for the credentialing process.
    • Performs updates to credentialing files and/or profiles as needed to ensure provider information is accurate.
    • Tracks and monitors provider credentialing/re-credentialing applications from submission to completion.
    • Loads provider information into credentialing database/tracking document or provider specific folders.
    • Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
    • Assists with credentialing audits; conducts internal file audits.
    • Performs query, report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
    • Monitors the initial, reappointment and expirables 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.
    • Responsible for following 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 the use of the PHI.
    • Performs other related duties as assigned.

    Contracts -

    • Reviews contracts and contract amendments for fee schedules and other terms and provide feedback to executive leadership.
    • Maintains contract files with health plans and other state or federal funders, managed care organizations, and state Medicaid systems.
    • Handles all communications and escalations while working the in-networking process.
    • Tracks re-credentialing deadlines and file re-credentialing paperwork, as well as any changes in credentialing (such as change of address, etc.).
    • Manages open items and deadlines to ensure timely processing of applications and execution of contracts.
    • Monitors and tracks submissions and status changes with payers and update internal records.
    • Maintains and updates existing records and create new records and reports.
    • Supports executive leadership and directors with special projects and perform other duties as assigned.





    • Maintain an approachable and appropriate attitude when communicating with internal and external clients and respond timely to requests, emails, voicemails, etc.
    • Ability to be very discrete with confidential information.
    • Possesses ability to work independently as well as part of a team with flexibility and willingness to learn and take initiative on variety of tasks and projects in a dynamic environment.
    • Ability to work independently, with a high degree of self-motivation, goal achievement orientation and strong practical problem solving acumen.
    • A high level of accuracy, attention to detail, and process orientation with strong organizational and multi-tasking skills.
    • Exceptional written and verbal communication, interpersonal and customer service skills.
    • Excellent computer skills, including but not limited to Word, Excel, Outlook and other Microsoft Office products. Knowledge of related accreditation and certification requirements.
    • Skill and experience in reviewing contracts.
    • Knowledge of medical credentialing and privileging procedures and standards.
    • Ability to analyze, interpret and draw inferences from research findings, and prepare reports.
    • Working knowledge of clinical operations and procedures.
    • Informational research skills.
    • Ability to use independent judgment to manage and impart confidential information.
    • Database management skills including querying, reporting, and document generation.


    • High school diploma or GED;
    • At least 5 years of experience in a new healthcare payer enrollment, contracting and credentialing role, preferably with a behavioral health agency.
    • Prior professional contacts and relationships with payers preferred, but not required.
    • Certification/Licensure NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) preferred.
    • Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.


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