What are the responsibilities and job description for the Senior Credentialing Specialist position at Insperity?
Description & Requirements
As one of the nation's largest groups of physicians specializing in the care of patients with renal disease, Arizona Kidney Disease and Hypertension Centers (AKDHC) has enjoyed the trust of patients and the respect of the community throughout the Phoenix Metropolitan area and across Arizona since 1976. We are a professional medical association comprising of physicians and other essential support staff. To learn more about us, please visit our website: www.akdhc.com.
Senior Credentialing Specialist
AKDHC is seeking an experienced Senior Credentialing Specialist to support provider credentialing, recredentialing, and enrollment for a busy private medical practice. This role is responsible for managing the credentialing process for physicians and advanced practice providers with health plans, hospitals, dialysis facilities, and other entities as applicable.
The ideal candidate will have strong health plan credentialing experience, excellent organizational skills, and the ability to manage multiple deadlines in a fast-paced environment.
Key Responsibilities
- Coordinate and manage initial credentialing, recredentialing, and provider enrollment activities for physicians and advanced practice providers
- Prepare, submit, and track credentialing and recredentialing applications with health plans, hospitals, dialysis facilities, and other entities as applicable
- Maintain accurate and current provider files, credentialing records, and supporting documentation
- Manage credentialing information within Modio and ensure provider data, supporting documents, statuses, and follow-up items remain accurate and up to date
- Maintain and update CAQH profiles and attestations, ensuring all provider information is current and complete
- Monitor application statuses and follow up with health plans, hospitals, dialysis facilities, and other entities to ensure timely processing
- Obtain, verify, and maintain required credentialing documents, including licenses, board certifications, malpractice coverage, DEA certificates, CME, and other applicable materials
- Track expiration dates and renewal requirements for licensure, certifications, and other provider credentials
- Serve as a liaison with providers, practice leadership, health plans, hospitals, dialysis facilities, and internal departments regarding credentialing matters
- Ensure provider data is accurate and updated across credentialing databases, payer portals, and internal systems
- Assist with roster management and provider demographic updates as needed
- Maintain knowledge of current credentialing standards, regulatory requirements, and payer-specific guidelines
- Support audits, reporting, and other credentialing-related projects as assigned
Qualifications
- Minimum of 4 years of credentialing experience required
- Direct health plan credentialing experience required
- Associate’s degree preferred; equivalent relevant work experience will be considered
- Strong understanding of provider credentialing, recredentialing, and enrollment processes
- Experience working in a medical practice, physician group, or healthcare organization preferred
- Strong attention to detail and ability to manage multiple projects and deadlines
- Excellent written and verbal communication skills
- Proficiency in Microsoft Office and credentialing/database systems
Arizona Kidney Disease and Hypertension Center (AKDHC) is an equal opportunity employer that welcomes and encourages diversity in the workplace. We do not discriminate based on race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected under federal, state, or local law.