Credentialing Specialist

Company Description

Valley Perinatal Services (VPS) specializes in providing exceptional care for high-risk pregnancies through a team of Maternal Fetal Medicine (MFM) specialists, nurse practitioners, midwives, and skilled sonographers. Focused on collaborating with expectant mothers and their OB teams, VPS is committed to delivering better health outcomes for both mothers and their babies. With a patient-first approach, the team at VPS works to achieve the healthiest gestational outcomes and support safe deliveries while minimizing complications. Located in Mesa, AZ, VPS continues to lead the way in delivering high-quality maternal and fetal care.

Role Description

This is a full-time, on-site Credentialing Specialist role based in Mesa, AZ. The Credentialing Specialist will be responsible for managing the credentialing and re-credentialing processes for healthcare providers, ensuring compliance with all applicable regulatory standards. Responsibilities will include verifying staff credentials, handling Medicare-related credentialing, maintaining accurate records, and liaising with providers and insurance companies. The role will also involve ongoing communication with staff to ensure the highest quality standards in medical credentialing and customer service.

Responsibilities

Inventory and update providers credentialing documents

Submission and follow-up of initial and reappointment applications practice divisions

Communicate with providers to resolve pending items

Collaborate with compliance regarding provider exclusion verification and updates

Escalate to supervisor unresolved items needing further review

Maintain and report provider and facility credentialing dashboard

Communicate with providers to resolve pending items

Collaborate with compliance regarding provider exclusion verification and updates

Collaborate with billing and practice operations to resolve claim issues due to credentialing problems

Manage providers malpractice insurance coverage status

Resolve escalated items needing further review

Qualifications

• Operational knowledge of CAQH, PECOS, DEA, and State medical licensing board
• Experience in Credentialing and Medical Staff Credentialing
• Strong Communication and Customer Service skills
• Knowledge of Medicare processes and regulations
• Attention to detail and the ability to manage compliance standards
• Familiarity with medical or healthcare settings is a plus
• Proficiency in administrative tasks and organizational skills
• Bachelor's degree or equivalent experience in healthcare administration or a related field is preferred