RISE, Inc., a 35+ year old growth oriented non-profit multi-state organization with annual revenues of $100MM+ serving the developmentally disabled community, is seeking a Credentialing Specialist to work in its Mesa, AZ corporate office which is conveniently located at Greenfield Rd. & US 60.

The Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by hospitals, surgery centers, commercial payers, Medicare and Medicaid for RISE.

ESSENTIAL JOB FUNCTIONS:

• Responsible for oversight of all credentialing activities
• Credentialing and re-credentialing of providers to various health plans.
• Performs initial review of new payer contracts and suggests changes to discuss with Director
• Maintain provider profiles including credentials and licensing to ensure active status with various health plans
• Enroll new providers in various health plans
• Expand business network of credentialed health plans
• Experience with credentialing for OT/PT/ST and ABA preferred.
• Knowledge of medical billing and ICD-10, and CPT coding
• Experience working with public and private payers. Commercial and Medicaid.
• Knowledge and/or experience of the health plan websites, CAQH, Availity, CMS Medicare (PECOS), NPPS (NPI), state licensing boards and National Provider Data Bank

MINIMUM QUALIFICATIONS:

• Associates degree in Healthcare or Business Administration or equal experience in Medical coding
• Medical coding certification issued by NAMSS is preferred
• At least 2 to 5 years of experience credentialing
• Accurate and timely data entry
• Ability to work independently and as a team player
• Excellent time management and organizational skills
• Intermediate Microsoft Excel experience is preferred

The ability to type and enter data quickly, at a rate of around 50 words per minute, is also highly desirable.

If you require reasonable accommodation for any part of the application process or hiring process, please submit your request through one of the following methods listed below:

(a) Dedicated fax 866-268-8885
(b) Dedicated email [email protected]
(c) US mail
(d) Dedicated phone 1-866-242-2714: DISABILITY ACCOMMODATION REQUESTS ONLY

RISE is an Equal Employment Opportunity (EEO) employer. We embrace diversity in all its form. We provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.