Credentialing Analyst

Job Summary:

As a Credentialing Analyst at Advantmed, this position will play a vital role in ensuring that all healthcare professionals meet the necessary qualifications and requirements to provide services within our organization. They will be responsible for managing the credentialing and recredentialing processes, verifying and maintaining accurate provider information, and ensuring compliance with regulatory standards. Attention to detail, strong organizational skills, and ability to effectively communicate with various stakeholders will be critical for success in this role.

Responsibilities:

Credentialing Process Management:

• Coordinate and manage the credentialing and recredentialing processes for healthcare providers, ensuring timely completion and accuracy of applications.

• Collect and review provider information, including licensure, certifications, education, work history, malpractice insurance, and professional references.
• Conduct primary source verification of credentials through direct contact with licensing boards, educational institutions, professional organizations, and other relevant entities.
• Maintain up-to-date and accurate provider files, both physical and electronic, ensuring compliance with internal policies and regulatory requirements.
• Compliance and Quality Assurance:
• Ensure compliance with all applicable federal, state, and organizational regulations and standards, such as National Committee for Quality Assurance (NCQA), Joint Commission, and other accrediting bodies.
• Perform audits and regular reviews of provider credentials to identify and resolve any deficiencies or gaps.
• Maintain an understanding of industry trends and changes in credentialing requirements, updating processes and policies as necessary.

Provider Relationship Management:

• Establish and maintain effective working relationships with providers, assisting them with the credentialing process and addressing any concerns or inquiries.
• Communicate credentialing decisions to providers and relevant internal departments, ensuring clear and timely communication throughout the process.

Data Management and Reporting:

• Ensure accurate and timely entry of provider data into credentialing software systems or databases.
• Generate reports and metrics related to provider credentialing, including application status, expirations, and compliance rates.
• Analyze data to identify patterns, trends, and areas for improvement in the credentialing
• process.

Requirements

Qualifications:

• Bachelor's degree in Healthcare Administration, Business, or a related field (or equivalent work
• experience).
• Previous experience in healthcare credentialing or related field is strongly preferred.
• Knowledge of credentialing standards, regulations, and processes, such as those set forth by
• NCQA and The Joint Commission.
• Familiarity with medical terminology, licensure requirements, and provider specialties.
• Excellent attention to detail and ability to maintain accuracy while managing multiple tasks
• simultaneously.
• Strong organizational and time management skills, with the ability to meet deadlines and
• prioritize workload effectively.
• Proficient computer skills, including experience with credentialing software or databases.
• Excellent communication skills, both written and verbal, with the ability to effectively interact
• with healthcare providers, internal teams, and external organizations.

Benefits

• Health, Dental, Vision insurance after 30 days
• 401k
• PTO