Credentialing Analyst Coordinator

Hybrid schedule - will be required to be in office and can also work from home

The Credentialing Analyst / Coordinator is responsible for the data analysis and/or the initialing credentialing and re-credentialing of nurse practitioners, physician assistants, Behavioral Health Providers and physicians in a compliant and timely manner; monitor expired credentials and compliance monitoring in accordance with Joint Commission accreditation, NCQA and URAC credentialing standards as required.

Position Summary

The Coordinator III will work directly with other coordinators to ensure quality of work delivered, performance/productivity benchmarks are met, and all compliance related issues are properly addressed, trained and coached on a consistent basis. The Enrollment Coordinators play a critical role in working with our new member clients to determine eligibility and perform various enrollment activities. Enrollment Coordinators interface with both individual plan members and employer group and requires a strong focus around accurate and timely customer support to ensure client enrollment and retention. The Enrollment Coordinator III reports directly to the Enrollment Supervisor, also functioning as SME (Subject Matter Expert) in the functions, processes, and eligibility procedures as they relate to Medicare Part D enrollment and CMS (Center for Medicare/Medicaid Services) Standards.

Responsible for the timely and accurate processing of all providers including NP’s/PA’s/MD’s Re-credentialing applications according to the Client Provider Credentialing Program

Monitor Expired licensure reporting , data base tasks and maintain system updates and weekly reporting to leadership

Manage Epic access for any providers that have out of compliance licensure and/or board certification.

Analyst will work directly with other coordinators to ensure quality of work delivered, performance/productivity benchmarks are met, and all compliance related issues are properly addressed, trained and coached on a consistent basis.

Conduct sanctions and compliance monitoring and alert Data Analyst Manager and Credentialing Manager of any undisclosed negative findings

Process malpractice insurance verification requests according to internal policies when applicable

Maintain the provider and physician SharePoint sites and Communicate provider status’s with leadership and other internal teams to meet timelines

Submit system access requests upon credentialing approvals/clinic eligibility

Support the payer enrollment team as needed to resolve any payer claim issues

Monitor Provider and Clinic change/Termination reports and update data base accordingly Process Name changes according to the client policies and procedures

Daily maintenance of provider credentialing grids with notification to appropriate teams

Review and distribute all incoming mail as needed

Support Payer Audits in accordance with the client, Joint Commission and NCQA requirements

Maintain provider files with the most current information/documentation

Notify system analyst and leadership of any system and state agencies interruptions / updates / password changes

Make recommendations for process improvement and system efficiencies

Attend and engage in all team meetings

Model a positive attitude in interactions with team members

Duties

Data analysis and/or the initialing credentialing and re-credentialing of nurse practitioners, physician assistants, Behavioral Health Providers and physicians in a compliant and timely manner; monitor expired credentials and compliance monitoring in accordance with Joint Commission accreditation, NCQA and URAC credentialing standards as required.

Manage Epic access for any providers that have out of compliance licensure and/or board certification. Analyst will work directly with other coordinators to ensure quality of work delivered, performance/productivity benchmarks are met, and all compliance related issues are properly addressed, trained and coached on a consistent basis.

Monitor Provider and Clinic change/Termination reports and update data base accordingly

Process Name changes according to the client policies and procedures

Notify system analyst and leadership of any system and state agencies interruptions/updates/password changes

Required Qualifications:

Demonstrated understanding of initial credentialing and re-credentialing practices for medical professionals including primary source verification methods, compliance monitoring and expirable management.

Proficient in quantitative analysis

Understanding of Joint Commission Accreditation, NCQA and URAC credentialing standards.

Ability to function independently and utilize critical thinking skills to accomplish goals and objectives

Effective communication skills; verbal and written

Strong interpersonal skills including the ability to work well with internal and external stakeholders

Strong organizational skills and the ability to multitask

Competent user of Microsoft Office, Outlook, MDStaff, Word, and Excel

A minimum of 3 years experience in the healthcare industry with experience in credentialing

Preferred Qualifications:

NAMSS Certified Professional Credentialing Specialist (CPCS) certification

Education

Associate or Bachelors Degree required

Notes:

M-F 8am-4:30pm ET (hybrid schedule - will be required to be in office and can also work from home)

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status