Banner Health Credentialing Specialist in Phoenix, Arizona

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Good health care is key to a good life. At Banner Health, we understand that, and that’s why we work hard every day to make a difference in people’s lives. We’ve united under a common goal: Make health care easier, so life can be better. It’s a lofty goal, but it’s one we’re committed to seeing through. Do you like the idea of making a positive change in people’s lives – and your own? If so, this could be the perfect opportunity for you. Apply now.

BPA Reimbursement Services is responsible for claims processing, adjustments, refunds, reconsiderations, projects, incoming checks and cash, eligibility and claims funding for BHN. There is also a responsibility for the oversight of the BCBS Advantage reimbursement, adjustments and refund processes.

As a Credentialing Specialist you will be responsibler to ensure that the personnel of a facility, mainly healthcare, are proview applications, verify both individual and facility accreditation, maintain records of verification and work with auditors as needed. Maintain databases in which they would input new information or update existing information reperly trained, licensed and certified as mandated by state and federal regulations. In addition, you will ensure that all services offered by these industries meet standards set by state and federal government agencies. Regarding employee training, licenses, education, continuing education and relevant job experience.

Requirements:

Must be proficient in managing data experience know excel pivot tables; positive attitude

Strong knowledge and understanding of healthcare planning as normally demonstrated through

three years of credentialing and/or process management and operations experience.

Requires a basic knowledge of medical terminology, medical staff organization and extensive

knowledge of credentialing procedures.

Location:

Mesa Corp. Office

525 West Brown Rd.

Mesa, AZ 85201

Schedule:

Monday 6:30am- Fri 6:30pm

Training Mon- Fri. 8-5

Work remote after training

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About Banner Health Network & Banner Plan Administration

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.

About Banner Health

Banner Health is one of the largest, nonprofit health care systems in the country and the leading nonprofit provider of hospital services in all the communities we serve. Throughout our network of hospitals, primary care health centers, research centers, labs, physician practices and more, our skilled and compassionate professionals use the latest technology to make health care easier, so life can be better. The many locations, career opportunities, and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee.

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Job Summary

This position performs the department's credentialing work as outlined in the policies and procedures. Obtains all primary source information necessary for all organizational facilities and entities. The incumbent maintains records and the integrity of highly confidential information that is protected from discovery by applicable state statutes.

Essential Functions

  • Performs the appropriate (applicable) credentialing processes in a timely and complete manner.

  • Performs analysis and appropriate follow-up. Works with many individuals to acquire necessary materials and information, including, but not limited to: physicians, facility staff, professional staff and physicians office staff.

  • Performs relevant data entry into the database to ensure consistency and integrity of the data.

  • Processes appropriate queries for expired licensure, or any appropriate regulatory credentialing requirement and maintains documentation in the database.

Minimum Qualifications

Must possess a strong knowledge of business and/or healthcare as normally obtained through the completion of an associates degree.

Must possess a strong knowledge and understanding of healthcare planning as normally demonstrated through three years of credentialing and/or process management and operations experience. Requires a basic knowledge of medical terminology, medical staff organization and extensive knowledge of credentialing procedures. Must have experience in interacting with physicians and allied health professionals, their office credentialing representatives, and hospital personnel.

Must have excellent communication skills, both verbal and written, along with astute judgment in areas of human relations. Must demonstrate an ability to meet deadlines in a multi-functional task environment. Requires excellent organizational skills and operational knowledge working with work processing, spreadsheets, data entry, fax machines, and other computer related skills. Must, at all times, maintain efficiency and timeliness in all daily activities. Must be able to establish daily work priorities and work efficiently to contribute to the successful overall maintenance of the credentialing process. Provides optimal customer service to meet the organizations expectations.

Preferred Qualifications

National Certified Provider Credentialing Specialist (NCPCS) certification preferred.

Additional related education and/or experience preferred.

Job Number 222578

Facility Banner Health Network & Banner Plan Administration

Department Banner Health Network & Banner Plan Administration - Managed Care

Street Address 1441 N. 12th St.

City & State US-AZ-Phoenix

Shift Day

Position Type FT: Full-Time

Posting Category Administrative / Clerical