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Credentialing Specialist
Credentialing SpecialistThe Center for Orthopedic and Research E • Phoenix, AZ, US
Credentialing Specialist

Credentialing Specialist

The Center for Orthopedic and Research E • Phoenix, AZ, US
30+ days ago
Job type
  • Full-time
Job description

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.

    • #HOP

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    Credentialing Specialist • Phoenix, AZ, US