Credentialing Specialist - [Remote]

The Credentialing Specialist is responsible for coordinating and managing provider and facility credentialing, enrollment, recredentialing, and payer participation activities for America’s Rehab Campus (ARC). This position works closely with AHCCCS, commercial insurance carriers, and internal departments to ensure providers and facilities remain compliant, credentialed, and eligible for billing and network participation. 

The Credentialing Specialist maintains accurate credentialing records, monitors expiration dates and regulatory requirements, submits applications and updates, and assists with compliance and audit readiness. This role requires strong attention to detail, knowledge of AHCCCS and behavioral health credentialing requirements, and the ability to work independently in a remote environment while managing multiple deadlines and priorities. 

DUTIES AND RESPONSIBILITIES 

• Complete and manage provider credentialing and recredentialing applications with AHCCCS, commercial insurance carriers, and contracted networks 

• Coordinate facility credentialing, enrollment, and updates for behavioral health programs and locations 

• Maintain credentialing files and ensure all required documentation remains current and compliant 

• Monitor expiration dates for licenses, certifications, malpractice insurance, DEA registrations, CAQH attestations, and other required credentials 

• Submit and track AHCCCS provider enrollment applications, updates, and revalidations 

• Work with insurance payers regarding contracting, participation status, and credentialing follow-up 

• Maintain provider records within credentialing databases and internal tracking systems 

• Verify provider credentials including licenses, education, certifications, NPI numbers, sanctions, exclusions, and background screening requirements 

• Coordinate with HR, Compliance, Revenue Cycle, and Operations regarding onboarding and credentialing status 

• Assist with audits, surveys, and compliance requests related to credentialing documentation 

• Maintain knowledge of AHCCCS requirements, payer standards, and behavioral health credentialing regulations 

• Communicate credentialing updates and deficiencies to leadership and providers in a timely manner 

• Ensure credentialing timelines are met to avoid interruptions in billing or payer participation