Provider Credentialing Analyst

Provider Credentialing Analyst

  Not Disclosed

  Woonsocket, RI (100% Remote)

  6.0 Months

  Not Disclosed

  Not Disclosed

  Healthcare

  $-4/hour - $1/hour

Job Description

Position Summary:
Client is seeking an analyst experienced in health care or health plan compliance monitoring and auditing to join our Credentialing and Payer Delegation team. This position supports the credentialing compliance monitoring program activities, auditing, data collection, trend analysis and meeting timeliness for delegated payer deliverables.

Assists in the preparation of deliverables for payer and internal audit requests
Communicating professionally and respectfully in all forms of interaction
Works independently and meet deadlines with high quality and accuracy
Assist with credentialing tasks and collaborative projects as needed
Building and maintaining effective, positive internal and external customer relationships
Conducting ongoing monitoring to evaluate levels of regulatory credentialing and delegated payer compliance with contractual and requirements
Exhibiting client at Work Behaviors
Participating in team initiatives and projects and meeting deadlines and quality expectations
Participates in the development and ongoing implementation of quality improvement activities. Improve quality products and services, by using measurements and analysis to process, evaluate and make recommendations to meet QM compliance objectives
Performing credentialing business process functions as needed, performing scheduled and random credentialing file audits
Reviewing risk assessments while participating in ongoing monitoring and annual program evaluation and identification of areas where there can be process improvement

Experience
3+ years of related health care or health plan experience in credentialing compliance, auditing, and quality assurance
The ability to read, write, understand and apply written and verbal instructions with minimal assistance afterwards.
Proficiency in Microsoft Office Applications; Excel, Outlook, Word, and Teams
The ability to review, analyze, update data on shared spreadsheets and identify trends.
Strong attention to detail and the ability to multi-task in a fast-paced environment
MDStaff experience is preferred

Experience:
2 years’ experience with NCQA compliance
1 year MDStaff experience.
Proficient in Microsoft Office Applications; Excel, Outlook, Word, and Teams
The ability to create spreadsheets, analyze data and identify trends.
Independent time management in a work from home environment

Education:
Bachelor’s Degree (preferred)
High School Diploma or GED Required

Notes:
Mon-Fri 8:30a-5p EST (Training will be Mon-Fri 9a-430p for approximately 2 weeks)
Fully remote (never coming onsite)