Credentialing Coordinator at Hospice of the Valley – Phoenix, Arizona

Join Arizona’s largest, most prominent not-for-profit hospice, serving the valley since 1977.

Hospice of the Valley is a national leader in hospice care and has been serving the Phoenix metropolitan area since 1977. A mission-driven, not-for-profit organization, Hospice of the Valley employs compassionate, skilled professionals who are committed to excellence, enjoy teamwork, and contribute daily to our mission and culture of caring. Team members experience a friendly, supportive atmosphere, leadership support, autonomy, flexibility, and the privilege of doing meaningful, rewarding work.

Benefits:

• Supportive work environment with a culture of caring for patients and one another.
• Competitive wages and excellent benefit program.
• Generous Paid Time Off.
• Flexible schedules for work/life balance.

Position Profile

Responsible for overseeing and executing all aspects of the credentialing and re-credentialing processes for individual healthcare providers (physicians, advanced practice providers, allied health staff) and all HOV entities. This role ensures that all providers and entity licenses and accreditations are current and that the organization maintains full compliance with federal, state, and appropriate accreditation standards as well as meeting payor partner requirements.

Responsibilities

• Manages provider credentialing.
• Manages the timely processing of initial applications and re-credentialing paperwork for all medical staff members.
• Conducts comprehensive primary source verification of provider credentials, including education, training, licensure, board status, malpractice insurance, and work history.
• Utilizes authoritative databases (OIG Exclusion List (LEIE), CAQH Provider Data Portal, PECOS, National Plan & Provider Enumeration System (NPPES) and National Practitioner Data Bank (NPDB), Nursys and Board Certification Databases) to screen providers for disciplinary actions, exclusions, or sanctions.
• Assists with the enrollment and re-enrollment of individual providers with third-party insurance payers, Medicare, and Medicaid to ensure timely reimbursement.
• Ensures no licenses/certifications expire before renewal.
• Manages Entity credentialing.
• Tracks and manages renewal timelines for entity licenses including state health department licenses, CLIA waivers and DEA registrations.
• Submits revalidations as needed to ensure consistent licensure.
• Procures new Medicare numbers upon leadership request and ensures all entity Medicare numbers remain active as appropriate.
• Assists in preparing documentation for regulatory audits and reviews as applicable.
• Ensures facility policies and procedures related to credentialing remain compliant with current federal and state regulations.
• Verifies that all required entity-level documentation is available and current for managed care contracting purposes.
• Provides quality administrative support.
• Supports other related processes and administrative tasks as needed.
• Maintains and enhances professional skills.
• Adheres to high standards of personal and professional conduct.

Minimum Qualifications

• Minimum of 3-5 years of experience in a medical staff services or credentialing role, ideally involving both provider and facility responsibilities.
• Experience using specialized credentialing software.
• Experience with PECOS.
• Strong working knowledge of provider and entity credentialing requirements and processes.
• Knowledge of medical terminology.
• In-depth understanding of applicable compliance standards from relevant accrediting agencies

Preferred Qualifications

• Experience with primary care and specialty practices and hospice.
• Associate’s degree.
• Certified Provider Credentialing Specialist (CPCS) certification from the National Association Medical Staff Services (NAMSS) strongly preferred.

Hospice of the Valley is an equal employment opportunity employer. EOE/M/F/D/V