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Senior Credentialing Analyst

Primary Location: San Diego, CA
Additional Locations: CA-San Diego
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:
  • 3+ years experience in credentialing providers required
  • 5+ years in Healthcare industry setting preferred
  • College degree or equivalent work experience preferred.

Additional Job Information:
  • 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.

Required Skills:
General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, General Business - Consulting for Solutions, General Business - Turning Data into Information

Desired Skills:
General Business - Maximizing Work Practices, Service - Managing Organizational Dynamics, Service - Providing Solutions to Constituent Needs, Technology - Leveraging Technology, Technology - Selecting and Applying Technology Solutions

Functional Skills:
Administration / Operation - Data Entry, General Management - Data analysis & interpretation, Network Management - Provider data services

Legal - Certified Professional Credentialing Specialist (CPCS)

Potential Telework Position:

Percent of Travel Required:
0 - 10%

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

Benefit Eligibility:
Benefit eligibility may vary by position. Click here to review the benefits associated with this 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.

Click To Review Our Benefits (PDF)


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