TX STAR+PLUS Senior Credentialing AnalystPrimary Location: Dallas, TX
Additional Locations: TX-Dallas, TX-Ennis, TX-Grand Prairie, TX-Greenville, TX-Irving, TX-McKinney, TX-Plano, TX-Terrell Apply
Manages provider/producer requests for participation. Assess Credentialing Management Data (Business Review, Initial /Recredentialing/Off-cycle and ongoing license/sanction monitoring) for all network and non-network providers/producers. Ensures all provider/producer information is verified and accurately recorded/maintained facilitating member access, protection against substandard care and minimizing corporate risk. Develops and maintains standards/processes for credentialing data ensuring database integrity; compliance with legislative, regulatory and accrediting body requirements; and manages communication with other departments regarding credentialing processes and database improvements. Unit subject matter expert liaison to staff and customers. Identifies and resolves issues.
- Maintains highest performance of Credentialing Analyst functions.
- Provides education and training to providers/producers and/or internal customers on credentialing policy and procedures.
- Works collaboratively with network staff (local and regional) in issue/problem identification and resolution.
- Conducts ongoing process audit to evaluate compliance with standards and outcomes (e.g. quality, accuracy, timeliness).
- Audits timeliness and maintains resource material and/or library of available resources such as updated disks, paper references, internet, state license sources, etc.
- Provides coaching/mentoring to peers and co-workers. Assists with training to staff members.
- May provide functional leadership within unit (i.e. team lead or supervision).
- Creates and manages action plans for assigned projects relative to special network initiatives, workflow or quality improvements.
- Coordinates receipt of provider/producer data with outside vendors and other entities.
- Assists and maintains collections of data, tracking and reporting.
- Assesses business benefit and cost of existing technology-based service or product for competitive advantage.
- Monitors exception processes and outcomes, and recommends process improvements based on trend analysis. Interprets and handles highly sensitive investigative activity in preparation for CPC / ongoing sanction activity of at risk providers.
- College degree or equivalent work experience preferred
- Ability to communicate complex ideas in a logical sequence appropriate for the audience.
- Ability to determine potential for adverse business risk, including good investigation skills.
- Possesses a basic knowledge of credentialing accrediting agencies and their standards and guidelines.
- Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.
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