Credentialing Analyst

Credentialing Analyst

  Not Disclosed

  Cumberland, RI

  6.0 Months

  Not Disclosed

  Not Disclosed

  Healthcare

  $19.99/hour - $24.99/hour

Job Description

Description:

Position Summary

The Coordinator III will work directly with other coordinators to ensure quality of work delivered, performance/productivity benchmarks are met, and all compliance related issues are properly addressed, trained and coached on a consistent basis. The Enrollment Coordinators play a critical role in working with our new member clients to determine eligibility and perform various enrollment activities. Enrollment Coordinators interface with both individual plan members and employer group and requires a strong focus around accurate and timely customer support to ensure client enrollment and retention. The Enrollment Coordinator III reports directly to the Enrollment Supervisor, also functioning as SME (Subject Matter Expert) in the functions, processes, and eligibility procedures as they relate to Medicare Part D enrollment and CMS (Center for Medicare/Medicaid Services) Standards.

Duties


Data analysis and/or the initialing credentialing and re-credentialing of nurse practitioners, physician assistants, Behavioral Health Providers and physicians in a compliant and timely manner; monitor expired credentials and compliance monitoring in accordance with Joint Commission accreditation, NCQA and URAC credentialing standards as required.
Manage Epic access for any providers that have out of compliance licensure and/or board certification. Analyst will work directly with other coordinators to ensure quality of work delivered, performance/productivity benchmarks are met, and all compliance related issues are properly addressed, trained and coached on a consistent basis
The Credentialing Analyst / Coordinator is responsible for the data analysis and/or the initialing credentialing and re-credentialing of nurse practitioners, physician assistants, Behavioral Health Providers and physicians in a compliant and timely manner; monitor expired credentials and compliance monitoring in accordance with Joint Commission accreditation, NCQA and URAC credentialing standards as required.


Responsible for the timely and accurate processing of all providers including NP’s/PA’s/MD’s Re-credentialing applications according to the client Provider Credentialing Program
Monitor Expired licensure reporting , data base tasks and maintain system updates and weekly reporting to leadership
Manage Epic access for any providers that have out of compliance licensure and/or board certification.
Analyst will work directly with other coordinators to ensure quality of work delivered, performance/productivity benchmarks are met, and all compliance related issues are properly addressed, trained and coached on a consistent basis.
Conduct sanctions and compliance monitoring and alert Data Analyst Manager and Credentialing Manager of any undisclosed negative findings
Process malpractice insurance verification requests according to internal policies when applicable
Maintain the provider and physician SharePoint sites and Communicate provider status’s with leadership and other internal teams to meet timelines
Submit system access requests upon credentialing approvals/clinic eligibility
Support the payer enrollment team as needed to resolve any payer claim issues
Monitor Provider and Clinic change/Termination reports and update data base accordingly
Process Name changes according to client policies and procedures
Daily maintenance of provider credentialing grids with notification to appropriate teams
Review and distribute all incoming mail as needed
Support Payer Audits in accordance with client Joint Commission and NCQA requirements
Maintain provider files with the most current information/documentation
Notify system analyst and leadership of any system and client interruptions / updates / password changes
Make recommendations for process improvement and system efficiencies
Attend and engage in all team meetings
Model a positive attitude in interactions with team members

Required Qualifications:

Demonstrated understanding of initial credentialing and re-credentialing practices for medical professionals including primary source verification methods, compliance monitoring and expireable management.
Proficient in quantitative analysis
Understanding of Joint Commission Accreditation, NCQA and URAC credentialing standards.
Ability to function independently and utilize critical thinking skills to accomplish goals and objectives
Effective communication skills; verbal and written
Strong interpersonal skills including the ability to work well with internal and external stakeholders
Strong organizational skills and the ability to multitask
Competent user of Microsoft Office, Outlook, MDStaff, Word, and Excel
A minimum of 3 years experience in the healthcare industry with experience in credentialing

Preferred Qualifications:

NAMSS Certified Professional Credentialing Specialist (CPCS) certification

Education

Associate or Bachelors Degree required
safety sensitive

Notes:

M-F 8am-4:30pm ET (hybrid schedule - will be required to be in office and can also work from home)