Provider Enrollment - Central Ave (5077)

We are pleased to share an exciting opportunity at Terros Health for an Provider Enrollment Specialist to join our team in Phoenix, AZ. 

Terros Health is a healthcare organization of caring people, guided by our core values of integrity, compassion and empowerment. We engage people in whole person health through an integrated care delivery system, thus establishing a medical home for our patients.  In caring for the whole person, we focus on overall wellness through physical health, mental health and substance use care.  Our mission is to provide extraordinary care by empowered people through exceptional outcomes.

Responsible for leading, coordinating, monitoring, and maintaining the provider enrollment process to ensure all staff practitioners meet and maintain enrollment requirements for CAQH, Health plans and state agencies. Responsible for the accuracy and integrity of Credential MyDoc credentialing database system with internal policies and procedures, client health contracts and applicable state and federal requirements.

"Most Admired Companies of 2023" as awarded by AZ Big Media.

Duties Include:

• Leads, coordinates, and monitors provider enrollment which process obtaining, verifying and assessing the credentials of all licensed and certified practitioners. Able to navigate each of the health plans website to submit enrollments. 
• Creates and maintains all database fields for providers in CredentialMyDoc for accurate reporting.
• Utilizes CredentialMyDoc database to manage the provider enrollment credentialing process and uses the database for tracking credentialing dates, storing credential documents, performing queries, reports and document generation and payor information.
• Monitor expiring licensure, board and professional certification and other expiring documents with practitioners within the prescribed timeframe. 
• Responsible for gathering, verifying evaluating highly confidential and sensitive health care practitioner credentials consistent with departmental guidelines and accreditation standards into CredentialMyDoc.
• Maintain practitioner electronic data files for CredentialMyDoc utilizing Arizona Health Plan (AZAHP) and Council for Affordable Quality Healthcare (CAQH).  Keep current with Medicare revalidations
• Corresponds in a timely and appropriate manner directly with practitioners, co-workers, department heads and management staff as needed regarding credentialing status and issues. 
• Identifies issues that require additional investigation and evaluation; validates discrepancies and ensures appropriate follow-up.
• Attends JOCs with the health plans and has a professional relationship with each of the health plans provider representatives.  Responsible for all health plan directory updates (provider rosters) and corrections.  Shall submit initial and re-credentialing applications for Terros Health facilities. Connect providers with each of the health plans pharmacy requirements. 
• Interface with state and federal agencies such as: Arizona Health Cost Containment System (AHCCCS), Medicare, commercial and Medicaid health plans, other providers, licensing agencies, on a regular basis developing relationships benefiting the agency.  Requires strong interpersonal skills.
• Actively participates in team meetings and process improvement initiatives to continuously improve work product quality and efficiency.
• Use critical thinking skills to conduct follow-up with individual practitioners internal and external entities to resolve discrepancies identified during the credentialing process.
• Educates practitioners, department heads ad management staff as needed on health plan changes and utilizing CredentialMyDoc.

Benefits & Wellness:

• Multiple medical plans - incl. a no premium plan for employees and their families
• Multiple dental plans - incl. orthodontia
• Financial well-being - 401(k) with a company match, interest free medical line of credit, financial education, planning, and support
• 4 Weeks of paid time off in the first year
• Wellness program
• Child Care Support Program
• Pet Insurance
• Group life and disability insurance
• Employee Assistance Program for the