Credentialing Analyst

• Support overall licensing and credentialing efforts for a national virtual provider group
• Perform credential file audits for timeliness, documentation quality, and policy adherence
• Review files for accuracy and completeness of documentation from associated vendors
• Analyze performance data against predetermined standards
• Interact with internal clinical frontline staff and leadership to obtain information, provide status updates, and research issues for Credentials Committee review
• Use internal systems and run reports/queries to research provider questions and resolve issues
• Monitor license actions, complaints, and sanctions and obtain information for Managers' review
• Perform additional research, auditing, credentialing appeals management, special projects, delegation oversight, and site visits

• H.S. diploma or equivalent
• Minimum of 3 years' experience in a managed care environment
• Any combination of education and experience providing an equivalent background
• Familiarity with NPPES, PECOS, CAQH, and Medallion Platforms
• Strong organizational and time management skills
• Experience in NLC, Medicaid Provider Enrollment, and Provider Collaboration Agreement Management
• Experience working with frontline providers
• Must be within a reasonable proximity/commuting distance of one of the posting offices unless accommodation is granted as required by law
• General business hours, Monday through Friday
• Candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, unless an acceptable explanation is provided

Demonstrates expertise in credentialing and licensing processes within a managed care environment, with strong organizational and time management skills to ensure compliance and accuracy in documentation. Proficient in utilizing internal systems for data analysis and provider support.

• Credentialing Management
• NPPES Familiarity
• Medicaid Provider Enrollment
• Provider Collaboration Agreement Management
• Performance Data Analysis

• Credential File Audits
• Documentation Quality Review
• Policy Adherence Monitoring
• Data Analysis
• Report Generation
• Auditing
• Appeals Management
• Site Visits

• Organizational Skills
• Time Management
• Interpersonal Communication

• Managed Care
• Provider Group
• Credentialing Appeals
• License Actions
• Frontline Providers

• NPPES
• PECOS
• CAQH
• Medallion Platforms