Credentialing Specialist

Job Description

Job Description

Healthcare Outcomes Performance Company is a vertically integrated musculoskeletal outcomes management company. HOPCo manages physician practices, hospital service lines, population health and value-based care programs, and musculoskeletal delivery networks.

HOPCo is the managing partner of Arizona-based entities, CORE Institute, Northern Arizona Orthopaedics, CORE Institute Specialty Hospital, Michigan-based CORE Institute, and Florida-based Southeast Orthopedic Specialists Clinics and Musculoskeletal Specialty Hospital.

As HOPCo continues to grow, we are looking for a Credentialing Specialist to join the Credentialing Team. Please see below for the functions and requirements for this position.

ESSENTIAL FUNCTIONS

• Reviews and completes hospital and payor applications for all health care providers.
• Completes verification forms/letters for outside facilities.
• Maintain billing insurance grid, provider insurance grid and each individual physician’s spreadsheet up to date on current insurance changes.
• Track and maintain physician licensure(s), certification and CME credits.
• Maintain practitioner credentialing files.
• Maintain practitioner electronic file by keeping all applications/licensure current.
• Maintains all renewal applications for both hospitals/insurances.
• Has knowledge of Employee Handbook content along with established policies and procedures.
• Relies on instructions and pre-established guidelines to perform the functions of the job.
• Assists the Credentialing Supervisor in their job responsibilities/duties when necessary.

EDUCATION

• High school diploma/GED or equivalent working knowledge preferred.

EXPERIENCE

• 3-4 years of Credentialing experience.

REQUIREMENTS

• Must be able to communicate effectively with physicians, providers, licensing agencies, insurance payors and the public and be capable of establishing good working relationships with both internal and external customers.
• Some knowledge of insurance billing and hospital credentialing a plus.

KNOWLEDGE

• Knowledge of the credentialing process.
• Knowledge of computer systems.
• Knowledge of credentialing paperwork and timelines.
• Knowledge of credentialing timelines and regulations.

SKILLS

• Skill in establishing good working relationships with internal and external customers.
• Skill in organizing daily work assignments for various providers.
• Skill in managing multiple work assignments and set priorities.

ABILITIES

• Ability to establish good working relationships with internal and external customers.
• Ability to communicate effectively with physicians, credentialing agencies and staff.
• Ability to be organized and efficient in daily work activities/projects.

ENVIRONMENTAL WORKING CONDITIONS

• Normal office environment.
• Some travel within community.

PHYSICAL/MENTAL DEMANDS

• Requires sitting and standing associated with a normal office environment.
• Some bending and stretching required.
• Manual dexterity using a calculator and computer keyboard.

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