Provider Credentialing & Payer Enrollment Specialist

Unlock your potential for professional development! We are looking for a Full Time, Provider Credentialing and Payer Enrollment Specialist to join our KRMC Team!

Located in northwest Arizona, Kingman has a mild climate with stunning Arizona sunsets! In the shadows of beautiful mountain ranges and nearby lakes, Kingman is an outdoor enthusiasts' paradise with abundant sunshine and is a great community to live, work and play!

All KHI employees are expected to perform their respective tasks and duties in such a way that supports KHI’s vision of providing the region’s best clinical care and patient service through an environment that fosters respect for others and pride in performance.

• Exceptional Colleagues
  • Join us and you'll be a part of a culture where we support each other and celebrate what makes each of us a special person as we work together with integrity, compassion, teamwork, respect, and accountability.
  • Our leaders demonstrate their commitment by gathering feedback, supporting, and empowering team members to do their best work through regular leadership rounding.
• Health and Well-Being
  • Medical, Dental, Vision, Employer Paid HSA for HDHP participants, Robust Wellness and Employee Assistance Program, Employer Paid Group Life, Short & Long-Term Disability
  • Generous Paid Leave Accruals
  • 403b Retirement Plan with Employer Contributions
  • Employee Recognition Programs, Employee Discounts, and Employee Referral Bonus Program
  • Employee Identity Theft Protection
  • On-site daycare exclusive to our employees’ children of all ages
  • Employer Paid Employee Wellness Center Membership with fitness classes, personal training, indoor pool, racquetball, and basketball courts
• Career Growth and Development
  • Tuition Reimbursement/Scholarships for full-time employees
  • As a not-for-profit organization, our employees who have qualified student loans may be eligible for the Public Service Loan Forgiveness program
  • So much more!

• Successfully supports the full scale of the data collection and verification processes for the medical staff services and payer enrollment processes.
• Compile, evaluate, and present provider‑specific information for use by Medical Staff Services and in the Payer Enrollment process.
• Conducts primary source verification of initial and reappointment applications in accordance with Accreditation, Regulatory, and Medical Staff Bylaws. Obtains provider sanctions, complaints and adverse data.
• Communicates with Providers via e‑mail, phone, written, and face‑to‑face to gather all signatures and information necessary to complete the collection of data for new providers and updates to existing provider profiles.
• Coordinates the sharing of payer enrollment data needed for enrollment, contracting, and other related purposes with Providers, Medical Staff Services, Managers/Supervisors, Insurance Payers/Networks, etc.
• Data collected includes but is not limited to the collection of educational certifications of all degrees, Drug Enforcement Administration (DEA) number, State License number, Board Certification, CV, Malpractice Insurance, and state insurance.
• Maintains and manages data input and data integrity for the MD Staff electronic credentialing data management program.
• Processes requests related to physician maintenance in hospital and clinic HIS systems and communicates additions or changes to the appropriate parties.
• Oversees provider enrollment software upgrades and any on‑going changes with software applications.
• Keeps current with insurance plan requirements for plan compliance and successfully implements changes.
• Reviews State Report for corrections that may be necessary to Provider Maintenance.
• Maintains provider payer enrollment files in the MD Staff or other approved system.
• Maintains an accurate Physician Provider grid for all participating plans for the facility and clinics and communicates the grid to stakeholders on a regular basis.
• Maintains accurate provider membership directory with each network to ensure that all employed physicians are properly loaded in the vendor listing as contracted provider.
• Updates Facility payer enrollment with all payers.
• Works…