At HOPCo, we are dedicated to taking care of you so you can take care of business! Our robust benefits package includes the following:

• Competitive Health & Welfare Benefits
• Monthly $43 stipend to use toward ancillary benefits
• HSA with qualifying HDHP plans with company match
• 401k plan after 6 months of service with company match (Part-time employees included)
• Employee Assistance Program that is available 24/7 to provide support
• Employee Appreciation Days
• Employee Wellness Events

ESSENTIAL FUNCTIONS

• Manages the timely and accurate completion of health care professionals credentialing and re-credentialing applications
• Manages primary source verification and collection of documentation for licensing, board certifications, proof of professional liability insurance, National Practitioner Data Bank (NPDB) and/or other sources as required based on Joint Commission and NCQA standards, health plan requirements and credentialing policies
• Ensures the accurate collection and documentation of all required renewal certifications (expirables) within the required time frame including CME credits and reimbursement process for employed providers.
• Cross trains within department to support credentialing operations and provide back-up support for key functions as needed
• Ensures appropriate notification to hospitals, health plans and medical groups of provider demographic changes as well as required documentation in the credentialing database
• Manages the processing of provider network terminations
• Collects/receives/audits disciplinary, OIG, and other reports as required (i.e. State Licensing Board, NPDB and other sanctioning bodies); takes appropriate action
• Provides consistent and timely follow-up on all outstanding credentialing/re-credentialing files, escalating issues to appropriate leadership when necessary
• Establishes reliable file collection, scanning, data capture and data entry procedures into the credentialing database
• Monitors the timeliness, completeness and accuracy of data collection and entry processes
• Prepares credential committee reports, adverse action documentation and other required reports as requested

EDUCATION

• High school diploma or GED

EXPERIENCE

• Minimum two or more years of experience in credentialing is required

REQUIREMENTS

• Certified Professional Medical Services Management (CPMSM) or Certified Professional Credentialing Specialist (CPCS) certification or minimum two years or more required.