Credentialing Specialist

Banner Health • Phoenix, AZ

1d • $21 - $32 • Remote

About The Position

In this role as a Credentialing Specialist, you’ll serve as a key driver of the provider credentialing, ensuring healthcare providers and facilities meet all regulatory, payer, and organizational requirements. You will independently manage assigned credentialing files from start to finish—processing applications, performing detailed data entry, verifying licensure and expirations, and following up proactively to obtain missing documentation. Success in this role requires strong analytical skills, impeccable attention to detail, and the ability to navigate multiple systems. This position is ideal for a self‑motivated professional who thrives in a high‑volume, detail‑oriented environment and takes pride in maintaining data integrity, compliance, and service excellence every day. This Credentialing Specialist role is remote only for applicants who reside in the following states: Arizona (AZ), California (CA), Colorado (CO), Nebraska (NE), Nevada (NV), and Wyoming (WY). The schedule is Monday - Friday, 8am-4:30pm.
Banner Plans & Networks (BPN) 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 BPN, 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 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.

Requirements

• Must possess a strong knowledge of business and/or healthcare as normally obtained through the completion of an associate’s 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 organization’s expectations.

Nice To Haves

• National Certified Provider Credentialing Specialist (NCPCS) certification preferred.
• Additional related education and/or experience preferred.

Responsibilities

• 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.
• The incumbent performs and completes activities within the parameters established by the director and supervisor and as outlined in the facility/entity documents. Manages own duties and functions independently. Work requires the constant exercise of a high degree of independent judgment in response to complex and sensitive credentialing issues, decision making and discretion. Uses independent decision making processes and handles assigned duties in a meaningful and confidential manner with a minimum of supervision. Handles physician inquiries and problems within the scope of job function and keeps supervisors apprised of all issues as they occur. Department and hospital responsibility. Internal customers include facility medical staff services, physicians, hospital personnel, corporate staff, hospital management, and volunteers. External customers include but are not limited to regulatory/accrediting and licensing agencies, legal entities, state and national databases, other hospitals and the general public.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees