Credentialing Specialist

Description:

Since 1969, OCR has been local and physician-owned with strong ties to the community. With a talented, hardworking and friendly staff, we all work toward the common goal of serving the residents of CO, WY, and NE with specialty-focused care. We are experiencing tremendous growth and are looking to add talented people to our team in all of our locations!

The Credentialing Coordinator is responsible for all aspects of credentialing for all OCR medical staff providers, and practice locations. This includes maintaining up-to-date licensures and certifications ensuring all providers are credentialed, re-credentialed, appointed, and privileged with health plans, hospitals and ambulatory surgery centers. This position maintains accurate and detailed credentialing records, monitors Physician Board Certification status, regularly interfaces with hospitals, insurance companies and state agencies, as well as assists providers with completion of required forms.

Duties Include:

  • Completes all aspects of credentialing procedures for Medical Staff, Advanced Practice Providers, Facility and  practice locations, including but not limited to, onboarding, reappointment, document management, and payer enrollment.
  • Complies with all state and federal standards as related to credentialing processes.
  • Monitors and maintains accurate up-to-date credentialing documents for medical staff members and their clinical privileges.
  • Assists with preparation of credentialing applications for provider licensure, privileges, and certifications as applicable.
  • Promotes communication and collaboration among the facility medical staff offices, licensing agencies, and insurance carriers to complete credentialing and re-credentialing applications in a timely manner, as well as cultivate professional relationships with internal and external partners.
  • Facilitates the physician’s maintenance of certification to maintain their board certification.
  • Prepares updates and distributes credentialing status reports of new providers as deemed appropriate.
  • Handles confidential provider records and carries out  related functions with discretion and professionalism.
  • Works with HR on conducting background checks on all incoming providers.
  • Maintains accurate provider profiles on databases such as: Council for Affordable Quality Healthcare (CAQH), Provider, Enrollment, Chain and Ownership System (PECOS), and Centers for Medicare and Medicaid Services (CMS).
  • Maintains provider and payer rosters.
  • Attends and participates in required organization meetings and committees as requested.
  • Participates in professional development activities and maintains applicable professional affiliations and certifications as required.
  • Other duties as assigned.

Qualifications Include: 

  • High School diploma or equivalent Associate’s or Bachelor’s  degree in business or related area preferred.
  • Two years of experience in healthcare-related field with credentialing experience preferred.
  • Knowledge of insurance terminology and contractual agreements.
  • Familiarity with Medicare, Medicaid, HMO and commercial payer guidelines.
  • Advanced computer skills to include MS Office programs including Outlook, Excel, Word, and applicable software platforms to manage credentialing functions and perform internet-based research.
  • Excellent organizational and analytical skills along with the ability to work on multiple tasks and meet deadlines in stressful situations.
  • Certified Provider Credentialing Specialist (CPCS) preferred.

Physical Requirements: 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

(The phrases “occasionally”, “regularly”, and “frequently” correspond to the following definitions: “occasionally” means up to ⅓ of working time, “regularly” means between ⅓ and ⅔ of working time, and “frequently” means ⅔ and more of working time.)

  • The work environment is the typical office environment. The employee must be able to complete their work satisfactorily in an environment where there are significant distractions, including staff, patients, and vendors walking through and conversing, telephones ringing, conversations carrying over, loud noises, and interruptions to answer questions from others.
  • While performing the duties of this job, the employee is frequently required to sit and use hands to finger, handle, or feel objects, tools, or controls up to 8 hours a day. The employee frequently is required to talk or hear. The employee is occasionally required to stand; walk; reach with hands and arms, and stoop, kneel, crouch, or crawl.
  • Requires the ability to work under stressful conditions and/or irregular hours to meet deadlines.
  • The employee may occasionally lift and/or move up to 20 pounds and should do so in a sound and safe manner. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Job Type: Full-Time

Location: Fort Collins

Pay: $17.00 – $24.50 /hour, commensurate with experience

Benefits:

  • Medical, Dental, Vision coverage
  • Life and AD&D Insurance
  • Short Term and Long Term Disability Insurance
  • Retirement savings and profit sharing plan participation
  • Employee Assistance Program
  • Continuing Medical Education (depending on position)
  • Paid Time Off

*Benefit eligibility is dependent on employment status, and a waiting period may apply.

Orthopaedic & Spine Center of the Rockies (OCR) is an Equal Opportunity Employer and prohibits discrimination or harassment of any kind. OCR is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment. All employment decisions are based on business needs, job requirements and individual experience and qualifications, without regard to a person’s race, color, age, sex, gender identity, gender expression, marital status, sexual orientation, religion, creed, national origin, the presence of any physical or mental disability, or status as a disabled veteran, recently separated veteran, other protected veteran, or Armed Forces service medal veteran, or any other protected status.

  • Posting Information

  • Posting Date:

    October 13, 2020
  • Location:

    Fort Collins
  • Department:

    Central Services
  • Job Information

  • Shift:

    M-F
  • Job Type:

    Full Time (Business Office)
  • Pay Rate:

    $17.00 - $24.50 /hour, commensurate with experience

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