Job Description

Facility: Valleywise Behavioral Health Center - Mesa

Department: Managed Care Contract Admin

Schedule: Regular FT 40 Hours Per Week

Shifts: Days

Under the direction of the Director of Managed Care, this position is responsible for supervises the daily operations and activities of Managed Care Provider Enrollment, managing relationships with health plans and overseeing the processes for provider enrollment, credentialing, and delegated credentialing agreements for Valleywise Health facilities and professional providers.

 

JOB QUALIFICATIONS:

Education or equivalency:

  • Requires a Bachelor’s in Business, Finance, Health Care Administration or related field; or an equivalent combination of training and progressively responsible experience that will result in the required specialized knowledge and abilities to perform the assigned work in lieu of degree.

Experience:

  • Must have a minimum of five (5) years credentialing experience in a health care setting to include two years provider enrollment, credentialing, or network management experience.
  • Must have experience with medical and professional credentialing processes, policies and procedures, including delegated credentialing requirements, as well as the infrastructure needs necessary to support compliance with delegated credentialing arrangements.
  • Must Have experience with physician billing and claims payments system requirements as related to provider enrollment.

 

Specialized training:

  • None

 

Certification/licensure:

  • Prefer Certified Provider Credentialing Specialist (CPCS) certification

 

Knowledge, Skills, and Abilities:

  • Must have the Proficiency with provider credentialing, data collection and record management systems.
  • Must have the Moderate Proficiency with Microsoft Office Suite applications.   
  • Must be approachable, people oriented, and a good listener. 
  • Must be a change agent able to develop, implement and maintain policies and processes. 
  • Requires the ability to be a creative, independent thinker.
  • Must exhibit a high degree of professionalism, customer service, and enthusiasm, combined with the ability to build relationships with business and key stakeholders.
  • Must possess solid analytical and problem-solving skills along with the ability to utilize the appropriate management techniques to plan, organize, control and coordinate activities.

 

 

Application Instructions

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