Delegated Credentialing AnalystPrimary Location: Richmond, VA
Additional Locations: VA-Richmond Apply
- Maintains and updates provider demographic and contract information, including contractually sensitive or complex transactions, in appropriate systems in support of claims adjudication and provider directory.
- Works collaboratively with internal/external constituents to implement new networks and complex contractual arrangements.
- May provide technical and functional leadership within unit (i.e., team lead, subject matter expert).
- Directly contacts providers and/or outside vendors to clarify data quality issues.
- Conducts and manages audits of provider information and escalates issues for resolution as appropriate.
- Demonstrated ability to handle multiple assignments.
- Provider Data Services background (1-3 years) or Network background (1-3 years).
- Associate's degree or equivalent work experience.
- Meet with credentialing teams from our delegated provider groups.
- Obtain updated rosters.
- Process additions and termination for the group.
- Align the providers to the correct contracted rates.
- Work collaboratively with the Network Consultant assigned to the group to assure provider satisfaction.
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