What are the responsibilities and job description for the Credentialing Specialist position at HOPCo?
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 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
· Must 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 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 the community.
MENTAL DEMANDS
· Requires sitting and standing associated with a normal office environment.
· Some bending and stretching are required.
· Manual dexterity using a calculator and computer keyboard.