Credentialing Assistant

Healthcare Outcomes Performance Co. (HOPCo); Phoenix (AZ); On-site; USD 42,000 - 60,000; Full time

Job summary

Healthcare Outcomes Performance Company is seeking a Credentialing Assistant to review payer credentialing status for new providers, keep rosters updated, and maintain CAQH provider profiles. The role supports the Credentialing Supervisor and adheres to established policies and procedures.

The position requires strong communication with physicians and payors, plus healthcare experience. A high school diploma or equivalent is preferred, with knowledge of credentialing processes considered a plus.

Qualifications

• Ability to communicate effectively with physicians, providers, licensing agencies, payors, and the public.
• Some knowledge of insurance billing and hospital credentialing is a plus.
• Knowledge of the credentialing process is a plus but not required.
• Knowledge of credentialing timelines and regulations is a plus but not required.
• Minimum of three to four years of experience in healthcare.
• High school diploma/GED or equivalent working knowledge preferred.

Responsibilities

• Reviews and re-attests all provider’s CAQH profiles.
• Maintains billing insurance grid, provider insurance grid, and each physician’s spreadsheet up to date on current insurance changes.
• 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 and Credentialing Specialist in their job responsibilities/duties when necessary.

Skills

Communication

Insurance billing knowledge

Credentialing process knowledge

Credentialing timelines/regulations

Healthcare experience

Education

High school diploma/GED or equivalent

Job description

Overview

The Credentialing Assistant is responsible for reviewing the Payer Credentialing status for all new providers, maintaining all rosters, updating CAQH provider profiles, and more.

Essential Functions

• Reviews and re-attests all provider’s CAQH profiles.
• Maintains billing insurance grid, provider insurance grid, and each physician’s spreadsheet up to date on current insurance changes.
• 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 and Credentialing Specialist in their job responsibilities/duties when necessary.

Qualifications

• Must be able to communicate effectively with physicians, providers, licensing agencies, insurance payors, and the public; capable of establishing good working relationships with both internal and external customers.
• Some knowledge of insurance billing and hospital credentialing is a plus.
• Knowledge of the credentialing process is a plus but not required.
• Knowledge of credentialing timelines and regulations is a plus but not required.
• Minimum of three to four years of experience in healthcare.
• High school diploma/GED or equivalent working knowledge preferred.

Company

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.