Analyst, Physician Credentialing

Job Summary: 

The provider credentialing analyst is responsible for credentialing new providers and maintaining current provider files for our quickly growing medical group. This hire will partner with current credentialing staff and own the end-to-end credentialing process, including:submitting and tracking credentialing applications to various contracted managed care plans and government payors for oncoming providers; maintaining the data for all providers within the group; tracking the expiration of certification and licenses; and will act as a liaison between payors, external credentialing service firms, and medical staff, including physicians.

Duties/Responsibilities 

• Build the ArchWell Health credentialing workplan and processes, including all required credentialing for physicians and facilities as dictated by government payors and contracted managed care plans 
• Conduct all necessary credentialing for physicians and facilities, including:
• Conducting background checks
• Contacting licensing boards
• Reviewing license applications
• Obtaining education information
• Completing references
• Ensuring the facility is operating within state and federal regulations
• Own all payor reporting, including data reporting and monthly exclusion checks  
• Oversee ongoing renewals for all required physician licenses and credentials 
• Act as a liaison between government payors and managed care plans, outsourced credentialing services, and ArchWell Health medical staff, including providers

Required Skills/Abilities: 

• Must understand Medicare, Medicaid, and managed care plan credentialing requirements, and must be familiar with CAQH (Council for Affordable Quality Healthcare) 
• Must also be able to work/communicate with providers in a professional manner to assist in the completion of the CAQH applications 
• Knowledge of medical terminology, strong organization skills, good written communication skills, ability to work independently, and ability to conduct research while performing job duties 
• The position also requires a person who is able to communicate well with all levels of staff, physicians, and patient referral sources 

Education and Experience: 

• Bachelor’s degree preferred 
• At least three (3) years of medical credentialing and enrollment experience  
• Proficient PC skills 
• Embodies and serves as a role model of ArchWell Health's Values:
• Be compassionate
• Strive for excellence
• Earn trust
• Show respect
• Stay resilient
• Always do the right thing