Credentialing Analyst

Position Summary

The Credentialing Analyst is responsible for managing and maintaining accurate provider credentialing records to ensure compliance with organizational, state, and federal standards. This role involves verifying provider qualifications, processing applications, maintaining accurate provider data across systems, and supporting the credentialing team in delivering timely and accurate credentialing services. The position also includes provider data extraction, cleansing, reporting, and analytics to ensure data integrity across credentialing and claims systems.

Key Responsibilities

Credentialing Operations

• Review and process provider credentialing and re-credentialing applications.
• Verify provider licenses, certifications, education, work history, and malpractice history.
• Maintain accurate and up-to-date credentialing files in accordance with regulatory requirements.
• Communicate with providers, payers, and internal teams to resolve credentialing issues.
• Monitor expiration dates for licenses, certifications, and other credentials to ensure compliance.
• Ensure compliance with NCQA, CMS, and other applicable standards.
• Collaborate with the Credentialing Manager to improve processes and maintain quality standards.

Provider Data Management & System Maintenance 

• Perform provider data extraction from the credentialing system; clean and prepare data for inloading into claims transaction systems.
• Serve as the steward of provider data, ensuring accuracy, completeness, and consistency across credentialing and claims platforms.
• Conduct system maintenance specific to credentialing and claims system configurations to support credentialing-related requirements.
• Support updates, corrections, and data integrity across all platforms where credentialing data is housed.

Reporting & Analytics 

• Prepare and distribute weekly, monthly, and ad hoc credentialing reports.
• Support reporting and analytics needs using internal BI tools and the credentialing platform.
• Identify and analyze credentialing trends to support process improvement and leadership decision-making.
• SQL skills are a plus for advanced querying, data validation, and report development.

Required Qualifications

• Associate’s or bachelor’s degree in healthcare administration or a related field (preferred).
• Minimum 2 years of experience in credentialing or provider enrollment.
• Strong knowledge of credentialing standards and regulatory requirements.
• Proficiency in Modio credentialing software is required.
• Excellent attention to detail and organizational skills.
• Strong communication skills and ability to work in a fast-paced environment.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook).

Preferred Qualifications

• Experience with payer enrollment processes.
• Familiarity with CAQH and other credentialing platforms.
• Knowledge of NCQA and Joint Commission standards.
• SQL experience or familiarity with data tools (preferred but not required).

AMM BENEFITS

When you join AMM, you’re not just getting a job—you’re getting a benefits package that puts YOU first:

• Health Coverage You Can Count On: Full employer-paid HMO and the option for a flexible PPO plan.
• Wellness Made Affordable: Discounted vision and dental premiums to help keep you healthy from head to toe.
• Smart Spending: FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future.
• Work-Life Balance: Generous PTO, 40 hours of sick pay, and 13 paid holidays to enjoy life outside of work.
• Career Development: Tuition reimbursement to support your education and growth.
• Team Fun: Paid company outings and lunches because we work hard, but we also know how to have fun!