CREDENTIALING SPECIALIST

Arizona Department of Administration • Phoenix, AZ

5d • $60,800 - $62,000 • Onsite

About The Position

The Department of Economic Security (DES) is seeking an experienced and highly motivated individual to join our team as a Credentialing Specialist within the Division of Developmental Disabilities (DDD). DDD provides individuals with developmental disabilities, and their families, services and supports that are flexible, high quality, and member driven. These services provide individuals with opportunities to exercise their rights and responsibilities of independent decision-making and engagement in the community. Applicants for this position cannot be licensed or certified by the DDD Office of Licensing Certification and Regulation, cannot have a principal interest in or have a spouse or close family with principal interest in a DDD Qualified Vendor Agreement, and cannot be employed or subcontracted by a DDD Qualified Vendor.

Requirements

• Knowledge in: Credentialing, quality assurance, quality management, quality improvement, risk assessment and prevention.
• Data analysis, summary report writing, corrective action plan development, prevailing concepts and philosophies regarding developmental disabilities.
• Adult learning strategies utilized in the course of providing training.
• Organizational and corporate structures and management practices and procedures typically utilized in facilities that serve individuals with developmental disabilities.
• Contracting.
• Skills in: Oral and written communication and documentation.
• Public speaking.
• Analyzing large amounts of data.
• Educating and assisting Division staff, providers, and members on various quality management activities.
• Report writing Facilitating meetings; Providing leadership to employees.
• Interpreting contracts; Technical writing.
• Ability to: Learn and interpret Arizona Health Care Cost Containment System (AHCCCS) requirements, credentialing requirements.
• Center for Medicare and Medicaid Services grants requirements, and federal and state laws.
• Utilize computer technology (e.g., developmental database development and maintenance, desktop publishing, Microsoft Office Suite, etc.)

Nice To Haves

• A Certified Professional in Healthcare Quality (CPHQ) certification.

Responsibilities

• AHCCCS compliance w/ credentialing of Qualified Vendor Agencies contracted w/ DDD, policies/procedures, review, maintaining credentialing calendar, completing monthly/quarterly organizational initial & re-credentialing in preparation for the Med. Officer's & Credentialing Committee's review/approval, coordinating w/ the Contracts Unit for required credentialing docs., review all required primary sources for licensing, HCBS certification, etc.
• Responsible for all duties/responsibilities for the supervision of staff in the QA Unit. Includes hiring, training, 1:1 meetings, coaching, day to day oversight, completing Performance Appraisals (MAP), authorizing leave, approving ETE Time Cards, etc.
• Responsible for coordinating QM Standards in regards to credentialing with AHCCCS Chapter 950 policies compliance, including submitted data review, completing internal review tool, analyzing data, review with Health Plan Credentialing staff, and imposing possible corrective actions/compliance follow-up for the Division and the contracted Health Plans.
• Prepares agenda, minutes, files and facilitates the Credentialing Committee. Ensures confidentiality statements are current and members adhere to confidentiality. Completes all follow-up as assigned and reports back to the Committee.
• Responsible for the Division's AHCCCS 950 Exhibit Quarterly Report compiling the quarterly provisional, initial, & re-credentialing data end summaries for the Division & contracted health plans for the Medical Officer's review & signature. Process includes reviewing timeliness compliance with AHCCCS Policy 950 & providing data to the Medical Officer for review with the Health Plans' respective Credentialing Committees.
• Responsible for the completion of all required training, participation in unit meetings and various QA committees: SQMC, Peer Review, COQOC, etc. Develops publications as requested. Participates in ad hoc work groups and committees as requested.
• Completes activities associated w/contract deliverables including but not limited to monitoring AdSS during ORs & Oversight Meetings; reviews & evaluates documents, reports, & deliverables submitted by AdSS; aggregates AdSS info into Div deliverables w/AHCCCS; ensures timelines are met; reviews & is very knowledgeable of AHCCCS contract w/Division especially related to areas of your expertise & authority.

Benefits

• Affordable medical, dental, life, and short-term disability insurance plans
• Participation in the Arizona State Retirement System (ASRS) and long-term disability plans
• 10 paid holidays per year
• Paid vacation and sick time
• Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child.
• Deferred compensation plan
• Wellness plans
• Tuition Reimbursement
• Stipend Opportunities
• Infant at Work Program
• Rideshare and Public Transit Subsidy
• Career Advancement & Employee Development Opportunities

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed