Credentialing Specialist

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 15%

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Orthopedic Care Partners

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

Orthopedic Care Partners (OCP) is a leading and expansive network of orthopedic care providers, offering a comprehensive growth platform for orthopedic practices across the United States. OCP is known for its superior clinical reputation, scaled infrastructure, and outstanding patient experience. Through strategic partnerships and affiliations, OCP has become one of the largest orthopedic platforms, supported by over 138 physician partners and 42 clinics. They focus on maintaining clinical autonomy for practices, while leveraging shared resources to optimize value-based care. OCP is actively involved in Medicare’s BPCI Program and commercial bundled contracts, capitalizing on data analytics to enhance patient outcomes and reduce costs. Their commitment is to superior clinical outcomes and a great patient experience, while providing a vertically integrated clinical offering and strong physician alignment. The company is well positioned to thrive within the healthcare industry's shifts towards value-based care models.

📋 Description

• Complete initial credentialing and recredentialing applications for providers with commercial and government payers • Maintain accurate and up-to-date provider information in credentialing databases, payer portals, and internal systems • Maintain up-to-date CAQH profiles, including regular updates and re-attestations • Monitor and track application statuses, expirations, and renewals of licenses, certifications, and insurance contracts • Communicate with providers to collect required documentation and resolve discrepancies • Collaborate with billing teams to prevent credentialing status from delaying claims processing or payment • Respond to payer requests for additional documentation or clarification • Ensure compliance with federal, state, and payer-specific credentialing guidelines and timelines • Audit credentialing records for data integrity and compliance with internal policies • Maintain logs and reports on credentialing activities, status updates, and contract effective dates

🎯 Requirements

• High school diploma or equivalent required; associate or bachelor’s degree in healthcare administration or related field preferred • Minimum of 2 years of experience in healthcare credentialing or provider enrollment • Experience with commercial and government payers preferred • Proficiency in credentialing software • Proficiency with payer portals, including CAQH and PECOS • Proficiency with Microsoft Office Suite, particularly Excel and Outlook • Understanding of credentialing standards, payer requirements, and basic billing processes • Knowledge of HIPAA and healthcare compliance regulations • Understanding of claim adjudication, payment posting, and denial management processes • Excellent verbal and written communication skills • Ability to manage multiple credentialing timelines, follow-ups, and renewals • Ability to maintain confidentiality and comply with regulatory and privacy standards • Travel may be required to existing or new OCP locations