Physician Credentialing Analyst

The Physician Credentialing Analyst is responsible for supporting the organization’s credentialing and re-credentialing compliance programs, with a focus on Medicaid and Medicare provider enrollments. Provides analyses and reporting for the organization wide administration of the credentialing and re-credentialing compliance function. Evaluates and reports on compliance standards with internal policies and procedures and external vendor credentialing standards. Must be able to attend meetings on-site at the Corporate Miramar, Florida office.

• Brings to the attention of internal management any issues which could cause the organization potential losses due to adverse legal action or risk irregularities.
• Collects physician related documentation from programs to ensure credentialing process is coordinated accurately and timely in compliance with defined schedules.
• Conducts studies, performs research and prepares reports.
• Confers with Risk Management Department and Legal Department as needed to avoid potential compliance issues.
• Develop standard and ad hoc reports, templates, dashboards, scorecards, and metrics.
• Maintains accurate and up-to-date computerized database.
• Meet with management to discuss and clarify requests for projects, highlight issues, and make recommendations to address issues and priorities.
• Performs data analysis and utilizes results to create reports and presentations.
• Safeguards the integrity of the credentialing administration function by exercising good judgment, and sharing best practices among the programs.
• Serves as subject matter expert in the credentialing compliance function. Confers with program management and staff. Provides guidance to ensure proper documentation meets internal and external compliance standards.
• Serves as subject matter expert in the credentialing compliance function.
• Write detailed reports and make oral presentations to management.

QUALIFICATIONS

• Organizational, analytic, and problem solving skills
• Personal computer skills with knowledge of MS software
• Previous credentialing compliance experience required.
• Ability to maintain confidentiality and handle confidential information.
• Detail oriented with good organization skills.
• Ability to work independently.
• Ability to communicate, both verbally and in writing, with internal and external customers in a professional, courteous manner.
• Ability to communicate tactfully, verbally and in writing with department heads, managers, coworkers and vendors to resolve problems and negotiate resolutions.
• Working knowledge of computers, internet access, and the ability to navigate within an automated systems as well as a variety of software packages such as Outlook, Excel and Word.