CREDENTIALING ADMINISTRATOR

About the Role

Affiliated Dermatology is looking for a detail-oriented, resourceful Credentialing Administrator to join our administrative team. This role supports the credentialing, enrollment, and payer-related processes that allow our providers to care for patients across our Arizona practices.

This is a great opportunity for someone who understands the healthcare insurance world and enjoys figuring out how all the pieces fit together. While direct credentialing experience is valuable, we are particularly interested in candidates with experience in payer contracting, provider relations, health plan operations, provider enrollment, or healthcare revenue cycle functions who are interested in expanding their knowledge of credentialing.

You'll work closely with another experienced Credentialing Administrator and interact regularly with providers, health plans, payer representatives, and internal teams. Success in this role requires strong follow-through, attention to detail, and the confidence to research, question, and resolve payer issues when the answer isn't always straightforward.

What You'll Do

• Coordinate credentialing and recredentialing for physicians and advanced practice providers.
• Maintain accurate and complete credentialing records for new and existing providers.
• Manage provider enrollment, additions, terminations, demographic changes, and other updates with assigned health plans.
• Verify and maintain required provider credentials, including state licensure, board certification, DEA registration, education, and other applicable documentation.
• Work with commercial, Medicare, Medicaid/AHCCCS, and other health plans to complete enrollment and maintenance activities.
• Navigate payer portals and other credentialing systems to submit applications, monitor status, research requirements, and resolve outstanding issues.
• Maintain and update provider information within systems such as CAQH and other credentialing platforms.
• Develop strong working relationships with payer and provider representatives and know when and how to escalate an issue.
• Research discrepancies, conflicting information, enrollment issues, and payer requirements and follow them through to resolution.
• Monitor deadlines, recredentialing requirements, revalidations, and outstanding payer requests.
• Participate in payer/provider forums and stay informed of changes to health plan requirements and processes.
• Support EFT and ERA enrollment or related payer administrative functions as assigned.
• Maintain clear documentation of payer processes, contacts, requirements, and workflow changes.
• Partner with the Credentialing team to provide cross-coverage and ensure continuity during vacations, absences, or high-volume periods.
• Communicate professionally with providers, medical staff, health plans, and other internal and external partners.
• Maintain confidentiality and follow HIPAA, organizational, and applicable regulatory requirements.