Provider Enrollment

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.

Terros Health made the list!!

"Most Admired Companies of 2020, 2022 & 2023" as awarded by AZ Big Media.

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.  

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 Whole Family
• Personal and family mental and physical health access
• Professional growth & development - including scholarships, clinical supervision, and CEUs
• Employee perks and discounts
  • Gym memberships
  • Tuition at GCU and University of Phoenix
  • Car rentals

• Bachelor’s Degree and at least two years’ experience in provider enrollment/credentialing, auditing, risk management, or contracts preferably in an integrated managed care environment. 
• Knowledge of basic requirements for contracting, insurance, and credentialing/provider enrollment for integrated health services, clinical operations. 
• Knowledge of general rules and regulations governing state and federally funded programs.    
• Possess excellent analytical skills
• Ability to process electronic reports
• Proficient in Word and Excel.
• Must have valid Arizona driver’s license, be 21 years of age with minimum 4 years driving experience and meet requirements of Terros Health’s driving policy.
• Must have a valid Arizona Fingerprint Clearance card or apply for an Arizona fingerprint clearance card (Level 1) within 20 working days of assuming role.
• Must pass a TB Test upon initial hire and if exposed.

Physical demands of this position are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.