Axiom Care is a fast-paced, rapidly growing substance abuse treatment and sober living housing provider with locations in the Phoenix metro area and Apache Junction. We primarily serve low-income and justice-involved individuals who are seeking to change their life for the better. We achieve this by offering multiple levels of care along with medical services, evidence-based professional counseling, case management, housing assistance, employment assistance, and more.

Job Summary
The Claims and Credentialing Specialist will ensure all medical providers maintain current credentials and licenses to work legally in their field or specialty. The Claims and Credentialing Specialist is also responsible for maintaining an active status for all providers and processing insurance claims for medical services rendered and follow claims until paid. This position will also assist patients with HEA Plus applications.

Duties/Responsibilities
• Review documentation for accuracy for coding and billing purposes
• Submit claims and all communications pertaining to the claims being submitted.
• Keep and update active reports for billing and billable items.
• Utilization review (submitting and monitoring prior authorizations)
• Reviewing denials for reprocessing
• Posting insurance payments against claims in billing software
• Verifying eligibility of clients prior to billing
• Following-up on insurance eligibility for pending enrollments
• Attends meetings as needed for clearinghouse, billing, provider relations, etc.
• Ensures medical providers maintain current credentials and licenses.
• Completes initial and subsequent credentialing packets to active facility payor source.
• Responsible for maintaining current contracts effective and renewal dates for all payors
• Responsible for credentialling all new on-board providers and maintaining current providers on staff
• Responsible for Facility credentialling and follow up
• Review provider files for appropriate documentation required for the credentialling process
• Proficient in data entry
• Completing HEA Plus applications for qualifying patients and tracking the application status
• Coordinating Credentialing and RE-Credentialing applications and conduct document research
• Work with providers to ensure application information is submitted in a timely manner
• Responsible for coordinating, monitoring, and maintaining the credentialling and re credentialling process for health professionals
• Point of contact for credentialing needs for all new providers on staff and on board
• Perform other duties as assigned by management.

Required Skills/Abilities:
• Excellent verbal and written communication skills.
• Excellent interpersonal and customer service skills.
• Excellent sales and customer service skills.
• Excellent organizational skills and attention to detail.
• Excellent time management skills with a proven ability to meet deadlines.
• Strong analytical and problem-solving skills.
• Ability to prioritize tasks and to delegate them when appropriate.
• Ability to function well in a high-paced and at times stressful environment.
• Proficient with Microsoft Office Suite or related software.
• Maintains a high level of patience
• Active CPR and First Aid certification required
• Active Fingerprint Clearance Card
• Negative TB Test result within the past 12 months

Required Competencies
• Compliance and Ethics – Understands, supports, and demonstrates commitment to facility’s mission statement. Promotes an atmosphere for cooperation between corporate staff and other departments within the facility’s organizational framework. Understands and supports facility’s compliance and ethics programs. Takes personal responsibility for interacting with coworkers and clients in an honest, ethical, and fair manner.
• Planning and organizing – Organizing facility and provider contracts to ensure all documentation has been completed and submitted within the timeframe.
• Quality Orientation – Monitors and checks work to meet quality standards; demonstrates a high level of care and thoroughness; checks work to ensure completeness and accuracy.
• Collaboration – Builds constructive working relationships with clients/customers, other work units, community organizations and others to meet mutual goals and objectives. Behaves professionally and supportively when working with individuals from a variety of ethnic, social, and educational backgrounds.
• Client Care- Makes clients and their needs a primary focus of one’s actions; gains client trust and respect; meets or exceeds client’s expectations
• Cultural Competence- Cultivates opportunities through diverse people; respects and relates well to people from varied backgrounds, understands diverse worldviews, and is sensitive to group

Education and Experience
• High school diploma or equivalent.
• At least two years related experience required.

Physical Requirements:
• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.