Collaboration Opportunities:

The Analyst, Credentialing Operations team (PDM) collaborates with the Provider Data Management (PDM) team through our Jira ticking system.

What You Will Be Doing:

• Maintenance of provider data within the credentialing platform
• Ticket intake and triage for internal/externally submitted tickets.
• Responsible for credentialing and re-credentialing files, including both Type I and Type II files.
• Maintain working knowledge of and comply with NCQA credentialing and recredentialing guidelines.
• Maintain working knowledge of and comply with partner specific credentialing and recredentialing guidelines, policies, and procedures.
• Ongoing monthly monitoring of exclusions, sanctions, and adverse events
• Represent Credentialing department in meetings and delivering special projects and maintaining concurrent projects as assigned.
• Establishing and maintaining excellent relationships, internally and externally including communication to the leadership team.
• Maintain contractual service level and/or operational level agreements, as applicable.
• Shift Time: 2:30 PM to 11:30 PM

Qualifications - Required and Preferred:

• Bachelor’s Degree or equivalent years of work experience-Required.
• Excellent verbal and written communication skills- Required.
• Detail oriented with good organizational skills-Required.
• Ability to work in an agile space and adapt to fluctuating situations-Required.
• Takes initiative and works independently - Required.
• Ability to time manage and reprioritize tasks/projects as appropriate Required.
• Microsoft Office Suite, including Word, Excel, PowerPoint, Outlook-Required.
• Minimum of two to three years’ experience in healthcare field related to credentialing, provider enrollment, provider services, and/or configuration-Preferred.
• General understanding of US health care, Managed Care Organizations, Medicare and/or Medicaid-Preferred.