Provider Credentialing Analyst I

Safety Sensitive*



Screening Questions:

Notate city/state at top of resume

1. Excel is required - what experience do they have using MS Excel? (Need to know VLOOKUP's, how to filter/add comments (NOT note) in spreadsheet) - Need to manually input

2. How familiar are they with creating formulas within Excel? (Need to manually input data, NOT copy/paste data into sheets with pre-built formulas)

3. Explain how they use data mining?

4. Are they comfortable working during EST time zone? *their hours are set hours, no changes*

5. Do they have reliable internet at home?

6. They have a quiet place to work at home remotely? *Extremely important*



•** 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

Assist with credentialing tasks 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 Heart 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

-Proficient in Microsoft Office Applications; Excel, Outlook, Word, and Teams

-The ability to create spreadsheets, analyze data and identify trends.

-Strong attention to detail and the ability to multi-task in a fast-paced environment

-MDStaff experience is preferred



Education:

-Bachelor s Degree



Position Summary:



•** is seeking an analyst experienced in health care or health plan credentialing, 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.



Duties:



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 Heart 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:



2 years experience with NCQA compliance

1 year MD-Staff experience preferred.

1 year of credentialing software experience required. Application processing, NPI, NPDB and license verifications

3+ years of related health care or health plan experience in credentialing compliance,

auditing, and quality assurance

Proficient in Microsoft Office Applications; Excel, Outlook, Word, and Teams

The ability to create spreadsheets, analyze data and identify trends.

Strong attention to detail and the ability to multi-task in a fast-paced environment

MD-Staff experience is preferred

Independent time management in a work from home environment



Education:



Bachelor s Degree