Senior Credentialing AnalystPrimary Location: San Diego, CA
Additional Locations: CA-San Diego Apply
- 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.
- 3+ years experience in credentialing providers required
- 5+ years in Healthcare industry setting preferred
- 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.
- Proficient computer skills, including proficiency in Microsoft Word and Excel.
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