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Credentialing Coordinator

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Blue Cross Blue Shield of Arizona

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Location:
United States , Phoenix

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Category:
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Contract Type:
Not provided

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Salary:

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Job Description:

The Credentialing Coordinator facilitates the accurate and efficient Credentialing and Recredentialing of Medicaid Business Segment providers in alignment with State, Federal, and NCQA standards.

Job Responsibility:

  • Ensure timely and accurate processing of credentialing and recredentialing for both individual practitioners and organizations
  • Coordinate Credentialing Committee meeting, including preparing the agenda and documenting meeting minutes
  • Identify and communicate agenda items for Credentialing Committee to immediate leader
  • Facilitate prompt coordination with the Credentialing Verification Organization (CVO) and monitor Work in Progress file
  • Promptly address incoming files for processing
  • Review and maintain all applications for accuracy and completeness
  • Accurately and efficiently data enter primary source verification data into the credentialing database
  • Input credentialing decisions and dates into the credentialing database
  • Generate and mail approval letters to participating providers
  • Identify missing or erroneous information from the provider’s application, and communicate with the provider to obtain
  • Coordinate with Network Services and/or other internal departments on follow-up items needed to complete the credentialing process
  • Communicate with Network Services and/or other internal departments regarding status of provider and organizational credentialing
  • Maintain ongoing participation in cross-training activities
  • Provide recommendations and feedback regarding process improvements and/or standardization practices
  • Actively participate in staff meetings, team huddles, and one-on-one meetings
  • Engage in team building activities
  • Perform all other duties as assigned

Requirements:

  • 2 years of experience in a healthcare field
  • 2 years of experience in provider credentialing
  • High-School Diploma or GED in general field of study

Nice to have:

  • 2 years of experience in a healthcare field, preferably within a credentialing/recredentialing environment and knowledge of national accreditation and/or regulatory standards
  • Associate's Degree in general field of study
  • Certified Provider Credentialing Specialist (CPCS)
  • Thorough understanding of managed care principles and physician practice operations, with an understanding of health plan credentialing preferred

Additional Information:

Job Posted:
May 14, 2026

Employment Type:
Fulltime
Work Type:
Remote work
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