Credentialing Analyst

Credentialing Analyst

The Credentialing Analyst will be responsible for the credentialing process for our organization. This role is crucial to ensuring that our healthcare providers meet all of the necessary qualifications and credentials to deliver high-quality care to our members.  In addition, the Credentialing Analyst will assist in the cross-licensing process for our therapists.  

Key Responsibilities:

• Facilitate the initial and reappointment credentialing process for healthcare providers
• Conduct thorough verification and analysis of healthcare professionals’ credentials, licenses, certifications, education and work experience
• Identify and address any discrepancies or issues in credentialing documents promptly and escalate as needed
• Utilize electronic systems and databases to manage and track credentialing documents and status updates.
• Review provider credentialing files to ensure compliance with all payor requirements and NCQA accreditation standards
• Maintains up-to-date data (expirables) for each provider in credentialing databases and CAQH
• Ongoing follow-up with providers to ensure timely completion of required documents
• Work with Therapists to obtain cross-licensure and maintain good working knowledge of state licensure requirements and timeframes to obtain licensure
• Outreach to state licensing boards regarding status updates on providers’ licensure
• Maintains confidentiality of provider information
• Coordinate with internal departments, such as recruitment and network operations to ensure that providers are accurately and timely credentialed 
• Conduct ongoing monitoring and reporting and credentialing status
• Respond to inquiries from providers and internal departments regarding credentialing matters

Requirements:

• Associate’s degree in healthcare or a related field. 
• Minimum of 3 years experience in healthcare credentialing/verification
• Proficient use and maintenance of CAQH
• Knowledge of state specific credentialing/recredentialing requirements
• Experience with obtaining licensure for providers across multiple states preferred
• Demonstrated skills in problem solving and analysis and resolution
• Knowledge of credentialing standards/regulations and NCQA accreditation 
• Strong communication skills with the ability to build and maintain relationships providers and internal stakeholders.
• Excellent organizational skills with the ability to manage multiple priorities
• Ability to prioritize workload effectively and meet deadlines 
• Ability to remain flexible and adapt to changes in a fast-paced environment
• Strong analytical and problem-solving skills

Excellent attention to detail and ability to maintain accurate and timely records