Credentialing Analyst

Overview

The Credentialing Analyst manages the credentialing process for agency employees, subcontractors, and other agencies/individuals as assigned, ensuring providers meet and maintain the required qualifications, certifications and regulatory standards. This role ensures credentialing and primary source verification process complies with organizational policies, and accrediting agency, Federal, and State regulatory standards. This position works closely with Coordinated Care Organizations (CCO), Community Partners, and State and Federal agencies to ensure credentialing processes and policies meet standards and compliance requirements. Must be able to work independently and adjust to changing priorities, organize workload to meet the needs and deadlines of the organization, and maintain strictest confidentiality.

Responsibilities

• Develops and maintains provider enrollment materials and processes. Assists providers with completion of applications and credentialing paperwork.
• Initiates and tracks provider enrollment with insurance companies. Follows-up with insurance companies regarding provider participation status.
• Processes Medicare and Medicaid provider enrollment and third-party credentialing.
• Monitors credentialing and licensing statuses for all licensed clinical providers, tracking re-credentialing requirements and creating new workflows as needed. Tracks and monitors licenses remain active and in good standing.
• Coordinates with staff and outside agencies to obtain necessary information to perform the credentialing process.
• Assists licensed and certified staff with registration/certification applications and processes. Tracks registration/certification processes and communicates with state agencies regarding progress and follow-up.
• Manages the credentialing and re-credentialing processes for agency staff, subcontractors, and contracted facilities, including Nurse Practitioners, Licensed Mental Health Clinicians, Psychiatrists, and other licensed and certified healthcare professionals.
• Oversees hospital credentialing of Crisis Specialists. Serves as a liaison between Options and outside agencies to ensure completion of this process.
• Actively develops and carries out communication processes that ensure supervisors, managers, COO, and Medical Billing staff are kept updated as to progress in credentialing, background checks, registry status and other critical areas that impact agency performance and compliance.
• Works closely with the Medical Billing Department and CCO's to ensure credentialing information/data is accurate for billing and reporting purposes, researches issues, and makes adjustments as necessary.
• Performs National Provider Data Bank Queries and Primary Source Verification (PSV) of licensure and education, and participates in other compliance screening.
• Prepares for, and participates in, credentialing audits by outside agencies.
• Works with sensitive and confidential information, strictly adhering to confidentiality policies of the organization.

Qualifications

• Experience in healthcare provider credentialing required, behavioral health credentialing experience preferred.
• Combination of education and experience to provide the skills and abilities needed to perform the essential functions of the position.
• Possess flexibility to address changing priorities and projects within a fast-paced environment.
• Strong attention to detail and outstanding organization skills.
• Must pass state-required background and DMV checks; possess a valid OR driver's license and a satisfactory driving record. Candidate must be able to work independently and flexibly, under general supervision.
• Understanding of HIPAA laws regarding confidentiality of privileged information, and ability to follow verbal and written instructions.