Credentialing Specialist

Healthcare Outcomes Performance Company•Phoenix, AZ

41d•Hybrid

About The Position

Healthcare Outcomes Performance Company (HOPCo) is a vertically integrated musculoskeletal outcomes management company that manages physician practices, hospital service lines, population health and value-based care programs, and musculoskeletal delivery networks. As HOPCo continues to grow, we are looking for a Credentialing Specialist to join the Credentialing Team. This role involves reviewing and completing applications, maintaining provider information, and ensuring compliance with various requirements.

Requirements

High school diploma/GED or equivalent working knowledge preferred.
3-4 years of recent Credentialing experience.
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.
Knowledge of the credentialing process.
Knowledge of computer systems.
Knowledge of credentialing paperwork and timelines.
Knowledge of credentialing timelines and regulations.
Skill in organizing daily work assignments for various providers.
Skill in managing multiple work assignments and set priorities.
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.

Nice To Haves

Some knowledge of insurance billing and hospital credentialing a plus.

Responsibilities

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.