Credentialing Specialist

The CORE Institute; Phoenix (AZ); On-site; USD 45,000 - 60,000; Full time

Job summary

A healthcare outcomes performance company is seeking a Credentialing Specialist to manage healthcare provider applications and related documentation. Candidates should have at least 3-4 years of experience, strong organizational skills, and the ability to communicate effectively with varied stakeholders. This role is based in Phoenix, Arizona, and is essential in ensuring compliance with credentialing processes. The company offers a supportive work environment and opportunities for professional growth.

Qualifications

• 3-4 years of related experience in credentialing or healthcare environment.
• Knowledge of insurance billing and hospital credentialing is a plus.
• Knowledge of computer systems and credentialing paperwork.

Responsibilities

• Review and complete applications for health care providers.
• Maintain practitioner electronic files and track licensure/certification.
• Assist the Credentialing Supervisor with job responsibilities.

Skills

Effective communication

Establishing working relationships

Organizational skills

Managing multiple assignments

Education

High school diploma/GED or equivalent working knowledge

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 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 related 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

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.