Credentialing Specialist

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 Specialist to manage hospital and payer applications, verify licensure, and maintain practitioner credentialing files.

You will coordinate with physicians, licensing agencies, and payors, track CME credits, and ensure timely renewals, with some travel within the community.

A high school diploma is preferred, with 3–4 years related experience; strong communication and organizational skills are essential.

Qualifications

• High school diploma or GED preferred.
• 3–4 years of related credentialing experience.
• Must communicate effectively with physicians, agencies, and payors.
• Knowledge of credentialing processes and timelines.

Responsibilities

• Review and complete hospital and payer credentialing applications.
• Verify forms and letters for outside facilities.
• Maintain insurer grids and physician licensure records.
• Track CME credits and physician certifications.
• Assist Credentialing Supervisor as needed.

Skills

Relationship building

Prioritization

Multi-tasking

Education

High school diploma/GED

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.

Credentialing Specialist

Essential Functions

• Reviews and completes hospital and payer applications for all health care providers.
• Completes verification forms/letters for outside facilities.
• Maintains billing insurance grid, provider insurance grid and each individual physician’s spreadsheet up to date on current insurance changes.
• Tracks and maintains physician licensure(s), certification and CME credits.
• Maintains practitioner credentialing files.
• Maintains 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 is 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 setting 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.