What are the responsibilities and job description for the Credentialing Specialist position at The CORE Institute?
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 related 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.
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