The Credentialing Specialist is responsible for credentialing and recredentialing ASU Clinicians as well as enrollment with participating client health plans. Credentialing functions include, but are not limited to, processing ASU Credentialing Applications, performing primary source verifications and updating and maintaining ASU credentialing database in accordance with internal policies and procedures, client health plan contracts, NCQA guidelines as well as applicable state and federal requirements.
Days and schedule: Monday – Friday 8:00am – 5:00pm; with occasional Saturday.
- Ensure timely and accurate credentialing and recredentialing application submissions for each Clinician as it relates to each client health plan; monitor and report progress of each Clinician.
- Maintain timely and accurate data entry and periodically revise Clinician data in the ASU credentialing database; maintain Clinician paper and electronic data files for ASU Clinicians; use the Council for Affordable Quality Healthcare (CAQH) system to submit Clinician data as required by some client health plans to credential individual Clinicians.
- Enroll Clinicians with all appropriate client health plans; monitor and report on progress of each Clinician.
- Ensure all Clinicians who require collaboration agreements are appropriately assigned to a collaborating physician and the agreement is executed by both parties; monitor and report progress of each Clinician.
- Ensure employed Clinicians are enrolled under the ASU professional liability insurance plan; monitor and report progress on each Clinician.
- Respond to all Clinicians, client health plan and internal inquiries in a timely manner.
- Monitor expiring licensure, board and professional certifications and other expiring documents with Clinicians within the prescribed ASU timeframes as outlined in the policies and procedures, assisting Clinicians with timely renewal as appropriate and escalating to manager.
- Conduct sanctions and compliance monitoring and alert Manager of any undisclosed negative findings immediately.
- Keep Manager informed of potential credentialing or enrollment issues.
- Perform miscellaneous job related duties as assigned.
Three (3) years of office/clerical experience, which includes one (1) year in a directly related function; OR,Any equivalent combination of experience and/or education from which comparable knowledge, skills and abilities have been achieved.
- Evidence of an Associates in Business, Finance, Health Care or related field or high school diploma and relevant combination of education and experience.
- Experience with medical and professional credentialing processes, policies and procedures, including delegated credentialing requirements.
- Minimum one year hands-on credentialing experience in a health care setting to include familiarity with Clinician enrollment, credentialing or network services experience.
- Experience in working independently.
- Experience in managing multiple projects.
- Experience in analytical skills necessary to assess compliance, record, analyze and interpret data into meaningful formats.
- Evidence of effective written and verbal communication skills.
- Experience in adapting to change and meeting deadlines.
- Experience in work that requires to detail and high degree of accuracy.
- Experience in MS Office applications including Excel.
- Evidence of a Certified Clinician Credentialing Specialist (CPCS).
- Experience with MD-Staff or similar Clinician credentialing, data collection and record management system.
- Experience with National Committee for Quality Assurance, URAC and/or The Joint Commission guidelines and standards related to credentialing.
• Communicate effectively both orally and in writing
• Use computers effectively including inputting, reviewing and retrieving information, extended periods of viewing screen, and using mouse and keyboard
• Work in an office setting and use office equipment (e.g. scanners, printers, copiers, fax machines, telephones)
• Sit or stand for extended periods of time
The mission of the ASU Health Services is to provide high-quality health care that is accessible, affordable and compassionate in order to ensure the well-being and educational success of students at Arizona State University. Through our internal and external academic partners, the ASU Health Services faculty and staff are an integral part of the New American University. ASU Health Services is a member of the Mayo Clinic Care Network and is fully accredited by the Accreditation Association for Ambulatory Health Care. ASU Health Services facilities are beautiful, modern, efficient, and utilize an electronic health record (NextGen). ASU Health Services works with our other wellness departments to create a healthy campus model, and our physicians and nurse practitioners play a key role working with student leaders.
We are a coordinated group; practicing medicine with staff board certified physicians with specialties in family medicine, internal medicine, emergency medicine, sports medicine, rheumatology, and OB-GYN and with board certified nurse practitioners. To learn more about Health Services, please visit our website at http://students.asu.edu/health.
Arizona State University is a new model for American higher education, an unprecedented combination of academic excellence, entrepreneurial energy and broad access. This New American University is a single, unified institution comprising four differentiated campuses positively impacting the economic, social, cultural and environmental health of the communities it serves. Its research is inspired by real world application blurring the boundaries that traditionally separate academic disciplines. ASU serves more than 70,000 students in metropolitan Phoenix, Arizona, the nation's fifth largest city. ASU champions intellectual and cultural diversity, and welcomes students from all fifty states and more than one hundred nations across the globe.
ASU is a tobacco-free university. For details visit www.asu.edu/tobaccofree
Arizona State University is an Equal Opportunity/Affirmative Action employer.
Employment Verification Statement
ASU conducts pre-employment screening which may include verification of work history, academic credentials, licenses, and certifications.
Fingerprint Check Statement
This position is considered safety/security sensitive and will include a fingerprint check. Employment is contingent up successful passing of the fingerprint check.
Instructions to Apply
Application deadline is 11:59PM Arizona time on the date indicated.
Resumes should clearly illustrate how prior knowledge and experience meet the minimum and desired qualifications stated in this requisition.
Only electronic applications are accepted.
ASU does not pay for travel expenses associated with interviews, unless otherwise indicated.
Sun lovers and knowledge seekers can turn to Arizona State University (ASU) for a well-rounded college education. The research university...