Credentialing Analyst

Credentialing Analyst 21385862

A leading medical institution is seeking a Credentialing Analyst. The successful candidate will cultivate and manage efficient and compliant onboarding processes. The ideal candidate knows TJC, NCQA, CMS, DHS, DMHC, ACGME and other applicable accreditation/regulatory requirements. The company offers a great work environment!

Credentialing AnalystPay and Benefits:

• Hourly pay: $30/hr
• Worksite: Leading medical institution, (San Francisco, CA 94143 - Hybrid - 2-3 days in a month onsite)
• W2 Employment, Group Medical, Dental, Vision, Life, Retirement Savings Program, PSL
• 40 hours/week, 6 Month Assignment

Credentialing AnalystResponsibilities:

• Cultivate and manage efficient and compliant onboarding processes, including:

  • Pre-application intake and monitoring.
  • Application/enrollment submission and analysis.
  • Reappointment/revalidation and competency assessments.
  • Auditing and quality review of credentialing program.
  • Addressing discrepancies/flagged items.
  • Handling board actions and temporary/visiting privileges.
  • Generating health plan enrollment applications and tracking reports, ensuring enrollment into web-based systems for government payors.

• Serve as a functional expert for the Credentials Committee, CIDP, and/or CVO clients. Collaborate with department chairs on the scope of practice and new privileges. Handle administrative tasks for committees/CVO clients.

• Resolve disruptions to revenue channels due to medical staff data integrity. Partner with department leaders to ensure alignment with onboarding priorities. Establish priorities and initiate temporary privileges to optimize patient access.

• 10%: Initiate procedures and communication to administratively suspend/reinstate provider status and clinical access. Draft action plans for leadership approval and monitor actions through reinstatement for complaint resolution.

• 10%: Facilitate and lead quality/process improvement projects, including desktop procedures, privilege implementation, data integrity, workflow development, and training/education initiatives.

Credentialing AnalystQualifications:

• 3 years in a healthcare environment with emphasis in medical staff operations, academic medical centers and/or provider credentialing for third-party payors and health plans preferred.
• Bachelor's degree in a related area and/or equivalent experience/training.
• Certified Provider Credentialing Specialist (CPCS) within 18 months of hire from OMAG required to meet performance expectations of the role.
• Certified Professional Medical Services Management (CPMSM) preferred.
• Knowledge of TJC, NCQA, CMS, DHS, DMHC, ACGME and other applicable accreditation/regulatory requirements.
• Competency in a paperless computer environment and understanding of provider data integrity standards (credentialing software, MS Office suite, Adobe Professional, document scanning/storage, web-based applications and tools, etc.).
• Excellent ability to: interact with all levels of management; communicate effectively, both verbally and in writing; and, function within a team and independently.
• Ability to perform all commonly applicable functions in Microsoft Office Suite (Word, Excel, PowerPoint) and medical credentialing database application.
• Data analysis, research and reporting skills.
• Exceptional organizational skills and ability to set priorities as well as manage multiple demands effectively.
• Role models and promote best practices to maintain confidentiality and discretion to preserve.
• HIPAA/Peer review protections as well as attorney-client privilege, as warranted.
• Knowledge of compliant revenue/billing practices to mitigate fraud/waste/abuse impacts on organization priorities/work plans.