Credentialing Analyst Job Description

Credentialing Analyst Job Description

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Credentialing analyst provides analysis and interpretation of federal/state laws, local ordinances, federal treasury regulations, state administrative rules, federal/state court decisions, opinions of the Attorney General, and other documents.

Credentialing Analyst Duties & Responsibilities

To write an effective credentialing analyst job description, begin by listing detailed duties, responsibilities and expectations. We have included credentialing analyst job description templates that you can modify and use.

Sample responsibilities for this position include:

Analyst will work closely with Credentialing manager to validate that OptumRx Network pharmacies meet and maintain the appropriate credentialing requirements, quality management standards to serve as a Pharmacy Provider for OptumRx
Analyst will perform background checks on all employees/entities, further analytics to identify past/present associations with pharmacies terminated from the Pharmacy Network and/or engagement in FWA activity
Analyst will verify current on-hand inventory, acquire a complete listing of wholesalers
The role develops and maintain standards for database integrity and quality assurance, coordinates corrective activities to clean database and retain users, and manages communication processes with other departments regarding database improvements
Responsible for establishing and maintaining needed credentialing for providers, and for assisting internal areas in problem resolution such as denied claims
Re-credentialing existing clinical employees
Maintaining personnel files with up-to-date credentials
Maintaining all credentialing documentation
Maintains all master practice data to support downstream process, reports and applications
Maintains provider updates and terminations to support downstream process, reports and applications

Credentialing Analyst Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Credentialing Analyst

List any licenses or certifications required by the position: CPCS, PMP, IIBA, NAMSS

Education for Credentialing Analyst

Typically a job would require a certain level of education.

Employers hiring for the credentialing analyst job most commonly would prefer for their future employee to have a relevant degree such as Collage and Bachelor's Degree in Education, Associates, Pharmacy, Business, Finance, Computer Science, Law Enforcement, Business/Administration, Healthcare, Voice

Skills for Credentialing Analyst

Desired skills for credentialing analyst include:

Federal Requirements
Top industry dispensed medications
Federal / State Requirements and Administrative Rules for Pharmacies
Internet Explorer
Microsoft Office and web-based products and tools
Specific State Requirements to perform the Credentialing Review
Federal
NCQA regulations concerning credentialing

Desired experience for credentialing analyst includes:

Ability to peform in-depth research independantly
A working knowledge of business unit sales organizations and field sales operating practices
Prior vendor credentialing experience a big plus
Maintains website provider directory
Maintains all expiring documentation by tracking and obtaining all applicable documentation and ensuring primary source verification is completed in a timely basis according to regulations and policies
Maintains standardized data field dictionary

Credentialing Analyst Examples

1

Credentialing Analyst Job Description

Job Description Example
Our innovative and growing company is hiring for a credentialing analyst. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for credentialing analyst
  • Run ad hoc reports to meet the needs of various departments and entire system
  • Assist Director with monitoring of individual and department metric review
  • Ensures data entered into system is accurate and complete
  • Establish and maintain credentialing database access training procedures for new credentialing and provider enrollment staff
  • Maintains all applicable portal functionality
  • Maintains import and export functionality so as to meet and maintain all related initiatives
  • Maintain ongoing education to support cross-training opportunities among team
  • Performs as a solid team player and works closely with staff, specifically the Director and additional Data Management team members
  • Preparing and distributing provider Welcome Packages to new providers
  • Updating all partners, and systems with appropriate information
Qualifications for credentialing analyst
  • Advanced working knowledge of Microsoft Office and Windows Operating System preferred
  • Experience with HealthLine Systems ECHO credentialing software highly preferred
  • Experience with SQL database administration preferred
  • General understanding of the medical staff organization and Joint Commission/Healthcare Facilities Accreditation Program/National Committee for Quality Assurance standards
  • Excellent attention to details and problem solving skills required
  • Strong working knowledge of word processing, spreadsheets, data entry, data base experience and other computer related skills
2

Credentialing Analyst Job Description

Job Description Example
Our innovative and growing company is hiring for a credentialing analyst. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for credentialing analyst
  • Following up with payers, and providers regarding status of paperwork
  • Completing re-credentialing and CAQH attestation requirements
  • Working directly with management and providers to ensure all open issues are addressed and resolved
  • Ongoing training as required for position
  • Meet company Key Performance Indicators for the Provider Credentialing Team
  • Meet individual productivity and quality metrics
  • Review relevant government, IRS, and company specific information in vendor applications
  • Verify and validate vendor credentials prior to on-boarding
  • Input and update vendor information in internal tracking applications
  • Review and approve new account prospects based on established guidelines which includes includes reviewing all required documentation and site inspections
Qualifications for credentialing analyst
  • Must be willing to travel by air and ground
  • Experience as a former non
  • Commissioned officer (NCO) in the US Air Force
  • Preference for degree from a 2 or 4 year college
  • Requires a H.S
  • 2+ years of experience in vendor credentialing or procurement
3

Credentialing Analyst Job Description

Job Description Example
Our innovative and growing company is searching for experienced candidates for the position of credentialing analyst. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for credentialing analyst
  • Assists Database Administrator in design, upgrades, monitoring, and optimizing database performance, security, backup, recovery, and integrity of database management systems
  • Assists in monitoring database functionality necessary to support department processes and activities
  • Assists Database Administrator in implementing security measures to safeguard information in computer files against accidental or unauthorized damage, modification, or disclosure
  • Contributes in developing standards and written guidelines for the end-user
  • Assists in ongoing synchronization of reappointing providers
  • Manages the practitioner expirable process and ensures that updates are comprehensive accurate and documents are appropriately scanned into the database
  • Assists in ongoing credentialing and provider enrollment activities and fulfills all reporting responsibilities required for maintaining strong health plan relationships and successful credentialing delegation agreements
  • Obtain and analyze claims billing and payment data as necessary in the course of conducting an investigation of criminal or civil fraud
  • Analyst will verify current inventory, acquire a complete listing of wholesalers
  • Create, Schedule and Run both routine and ad-hoc reports from Credentialing Database
Qualifications for credentialing analyst
  • Strong technical skills across multiple platforms
  • Intermediate or greater proficiency with MS Excel
  • The Credentialing Compliance Analyst I would have a high school diploma or equivalent and 4 years of experience in Credentialing, Provider Network or Customer Service, or equivalent combination of education and experience
  • Audit experience and strong attention to detail
  • Knowledge of medical documents and procedures
  • Ability to work with people at all levels and exercise good judgement
4

Credentialing Analyst Job Description

Job Description Example
Our company is hiring for a credentialing analyst. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for credentialing analyst
  • Maintain and Monitor Web and Intranet portals for Credentialing Database
  • Provide customer service and troubleshooting for both internal and external Credentialing Database users
  • Identifies functionality problems with application and works with IT Department and vendors to coordinate resolution
  • Coordinates system-wide preparation of data for requests from administration, finance and other health care system needs
  • Interacts effectively with co-workers and able to work as part of a team
  • Two year experience in a medical staff or credentialing office or environment
  • Familiarity with credentials process and primary source verification
  • Familiarity with credentials software, preferably Cactus
  • Proficiency in database management and all aspects of Microsoft Office Suite
  • Ability to work in several software systems with some training
Qualifications for credentialing analyst
  • Ability to communicate professionally in person, on the phone, electronically, or by other means to individuals and groups
  • Knowledge of national credentialing standards and policies, applicable systems and provider contract language
  • Ability to multitask and remain continuously current on changes and/or additions to all other applicable departments’ policies, procedures and guidelines
  • 3+ years of experience in analysis experience with a solid understanding of data storage structures
  • Intermediate level of proficiency with PC based software programs and automated database management systems (Excel, PowerPoint, Word and Visio)
  • Credentialing Healthcare experience
5

Credentialing Analyst Job Description

Job Description Example
Our innovative and growing company is searching for experienced candidates for the position of credentialing analyst. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for credentialing analyst
  • The ability to manage multiple projects regarding provider demographics, meet state deliverables and ensure compliance is key in this role
  • Administrator for all aspects of Health Care Industry Representative (HCIR) credentialing
  • Provide credentialing expertise
  • Research and understand new internal and external requirements to determine if applicable to the field sales organization
  • Interface with medical facilities where appropriate to mutually agree on credentialing requirements
  • Partner with internal business partners to ensure protection of associate information
  • Negotiate and execute agreements with external business partners
  • Manage and provide day-to-day support for credentialing requests to fields sales associates, other departments as required, and external business partners
  • Initiate, develop and communicate credentialing policies and procedures to the field sales organization in accordance with industry standard requirements
  • Develop materials and educate new hires on the vendor credentialing process
Qualifications for credentialing analyst
  • Basic computer skills (MS Office/Outlook)
  • Possess sense of urgency while being able to focus and pay attention to detail
  • Strong Research skills using 3rd party tools preferred
  • Ability to prioritize and learn quickly in a production based environment
  • Investigative oriented
  • Strong decision making ability and is able to work independently

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