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TX STAR+PLUS Senior Credentialing Analyst

Primary Location: Dallas, TX
Additional Locations: TX-Dallas, TX-Ennis, TX-Grand Prairie, TX-Greenville, TX-Irving, TX-McKinney, TX-Plano, TX-Terrell
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Description:
At Aetna Better Health of Texas, we are committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of Texas STAR+PLUS, STAR/CHIP, and STAR Kids members. We value diversity and are dedicated to helping you achieve your career goals.

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.


Fundamental Components:
  • 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.


Background Experience:
  • 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.


Additional Job Information:
At Aetna Better Health of Texas, we are committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of Texas STAR+PLUS, STAR/CHIP, and STAR Kids members. We value diversity and are dedicated to helping you achieve your career goals.

Required Skills:
General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, General Business - Maximizing Work Practices, Leadership - Collaborating for Results, Service - Improving Constituent-Focused Processes, Technology - Leveraging Technology

Functional Skills:
Network Management - Credentialing

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft SharePoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Potential Telework Position:
No

Percent of Travel Required:
0 - 10%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position.

Candidate Privacy Information:
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

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