Credentialing Specialist

Department Name:

Credentialing

Work Shift:

Day

Job Category:

Administrative Services

Estimated Pay Range:

$20.01 - $30.01 / hour, based on location, education, & experience.

In accordance with State Pay Transparency Rules.

Banner Health was recently recognized on Forbes inaugural list of America’s Dream Employers 2025. This list highlights employers across the country that prioritize workplace excellence and the happiness, satisfaction, wellbeing and fulfilment of their employees.

Banner Plans & Networks (BPN) is a nationally recognized healthcare leader that integrates Medicare and private health plans. Our main goal is to reduce healthcare costs while keeping our members in optimal health. BPN is known for its innovative, collaborative, and team-oriented approach to healthcare. We offer diverse career opportunities, from entry-level to leadership positions, and extend our innovation to employment settings by including remote and hybrid opportunities.

As a Credentialing Specialist, you will leverage your Provider Credentialing Experience as a vital member of the Banner Plans & Networks Team. In this role your will provide leadership and support for the Population Health Services Organization (PHSO) Credentialing Committee activities. You will provide guidance to the members of the credentialing committee which includes a review of all providers who are seeking to and/or to maintain network participation. You will prepare risk files for committee review. You will prepare meeting minutes for approval. You will also complete a monthly file monitoring of completed files against credentialing standards. You will conduct monthly monitoring of licensing actions, exclusions, preclusions and Medicare Opt-Out of all providers within our networks and present your findings.

The position is fully remote, with work hours from Monday to Friday during standard business hours according to the Arizona Time Zone. If you're interested in this role, we encourage you to apply today!

Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.

POSITION SUMMARY
This position provides administrative services and assistance requiring occasional discretion and judgment. Coordinates a unique set of processes and/or services for an assigned area such as credentialing.. Responsible for coordination of multiple provider networks to include delegation agreements, manages committee structures, leads credential committee meetings.

CORE FUNCTIONS
1. Lead role in preparing documentation, create agendas, meeting invitations and facilitating the necessary materials for credentialing committee review. Facilitates the credentialing committee meeting.

2. Reviews and/or audits documents, forms or stipends for appropriateness/accuracy.

3. Corresponds with customers, team members, committee members, BHN leadership and senior leadership, legal, and medical leadership using defined formats and procedures, via verbal, electronic and written communications.

4. Maintains confidential records and required documentation for assigned area. Ensures appropriate documentation is timely and accurately entered into departmental application(s).

5. As assigned, prepares, collates, and distributes various reports in a timely and accurate manner. May complete or handle recurring department projects or one-time projects, as directed by supervisor.

6. Conducts internal team audits and reports findings to supervisor on a monthly basis.

7. Oversees the credentialing appeals process.

8. Works independently under general supervision. Represents the company as a primary point of contact to outside entities such as delegated health plans, community providers and offices, etc.

MINIMUM QUALIFICATIONS
Must possess a strong knowledge of business and/or healthcare as normally obtained through the completion of an associate’s degree and 3-5 years of credentialing and/or process management and operations experience in a related area.

Must have the ability to follow oral and written directions as they relate to the functions listed above. Must have excellent oral, written and interpersonal communication skills to effectively interact with departmental personnel, assist customers with inquiries, schedule meetings and appointments, as well as provide assistance with incoming telephone calls and walk-ins. Requires the ability to work effectively with common office software, including spreadsheets and word processing. Must have the ability to organize, prioritize and multi-task workload in a fast-paced environment and maintain a professional manner.

PREFERRED QUALIFICATIONS
Additional related education and/or experience preferred.

EEO Statement:

EEO/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

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