Credentialing Specialist - [Remote]

The Credentialing Specialist is responsible for coordinating and managing provider and facility credentialing, enrollment, recredentialing, and payer participation activities for America’s Rehab Campus (ARC). This position works closely with AHCCCS, commercial insurance carriers, and internal departments to ensure providers and facilities remain compliant, credentialed, and eligible for billing and network participation. 

The Credentialing Specialist maintains accurate credentialing records, monitors expiration dates and regulatory requirements, submits applications and updates, and assists with compliance and audit readiness. This role requires strong attention to detail, knowledge of AHCCCS and behavioral health credentialing requirements, and the ability to work independently in a remote environment while managing multiple deadlines and priorities. 

DUTIES AND RESPONSIBILITIES 

• Complete and manage provider credentialing and recredentialing applications with AHCCCS, commercial insurance carriers, and contracted networks 

• Coordinate facility credentialing, enrollment, and updates for behavioral health programs and locations 

• Maintain credentialing files and ensure all required documentation remains current and compliant 

• Monitor expiration dates for licenses, certifications, malpractice insurance, DEA registrations, CAQH attestations, and other required credentials 

• Submit and track AHCCCS provider enrollment applications, updates, and revalidations 

• Work with insurance payers regarding contracting, participation status, and credentialing follow-up 

• Maintain provider records within credentialing databases and internal tracking systems 

• Verify provider credentials including licenses, education, certifications, NPI numbers, sanctions, exclusions, and background screening requirements 

• Coordinate with HR, Compliance, Revenue Cycle, and Operations regarding onboarding and credentialing status 

• Assist with audits, surveys, and compliance requests related to credentialing documentation 

• Maintain knowledge of AHCCCS requirements, payer standards, and behavioral health credentialing regulations 

• Communicate credentialing updates and deficiencies to leadership and providers in a timely manner 

• Ensure credentialing timelines are met to avoid interruptions in billing or payer participation 

QUALIFICATIONS, CERTIFICATIONS, AND EDUCATION REQUIREMENTS: 

• High School Diploma or Equivalent required 

• Minimum of 2 years of credentialing experience required 

• Experience with AHCCCS provider enrollment and behavioral health credentialing strongly preferred 

• Knowledge of provider and facility credentialing processes for commercial and government payers 

• Experience with CAQH, NPPES/NPI Registry, sanction monitoring, and license verification systems 

• Understanding of healthcare compliance standards and payer requirements 

• Experience credentialing behavioral health providers and facilities 

• Familiarity with Joint Commission and AHCCCS compliance requirements 

• CPCS, CPMSM, or related credentialing certification preferred but not required 

• Strong attention to detail and organizational skills 

• Ability to manage multiple deadlines and prioritize workload independently 

• Strong written and verbal communication skills 

• Proficient with Microsoft Office, credentialing software, and electronic document management systems 

• Ability to maintain confidentiality and handle sensitive information appropriately 

• Minimum two (2) years of experience in behavioral health field preferred 

• Successful clearance of pre-employment criminal/county/state background check 

• Successful clearance of pre-employment drug and alcohol testing 

Additional Notes: 
America’s Rehab Campus’s is an Equal Opportunity Employer, a drug free workplace, and complies with Veteran and ADA regulations as applicable.