The Credentialing Analyst is responsible for analysis, evaluation, and validating provider information against business/credentialing requirements and maintains information in Credentialing databases and other data sources. The Credentialing Analyst’s goal is to see all providers credentialed for all plans and work closely with the Revenue Cycle Director to meet Revenue Cycle metrics.

ESSENTIAL FUNCTIONS

• Assists with developing metrics that will eliminate and/or reduce timely filling issues due to late credentialing of Mountain Park Health Center providers.
• Maintains an accurate database containing credentialing status by Provider and Plan.
• Coordinates with Plans maintaining accurate provider rosters by Plan.
• Completes provider credentialing and re-credentialing applications and submit credentialing packets to plans before providers start work.
• Obtains Arizona Health Care Cost Containment System (AHCCCS) and Medicare numbers for providers before providers start providing patient care.
• Holds plans accountable to credentialing new providers within rules and timeframes established for Federally Qualified Health Centers (FQHC’s).
• Partners with billing to resolve credentialing and billing issues.
• Maintains knowledge of Medicaid, Medicare, private health plans, and agency requirements for credentialing Providers.

• Sets up and maintains provider information for Council for Affordable Quality Healthcare (CAQH) databases and system.

• Ensures practice addresses and other key information are current with health plans, agencies, and other entities.
• Maintains Plan information by provider in credentialing database and uses system of alerts to proactively monitor credentialing deadlines.
• Creates system to track and respond to communication from Plans and credentialing requests in a timely fashion.
• Coordinates with Privileging and Human Resources (HR) to ensure initial credentialing forms are returned timely and accurately by new Providers.
• Performs other duties as required.

Minimum Qualifications:

• Bachelor’s degree and two years of credentialing experience or four years of credentialing experience if applicant does not possess a bachelor’s degree.

Preferred Qualifications:

• Certified Provider Credentialing Specialist (CPCS).