Provider Credentialing Analyst

Client bill rate max ***
Supplier bill rate ***

*Safety Sensitive*

Screening Questions:
Notate city/state at top of resume
1. Excel is required - what experience do they have using MS Excel? (Need to know VLOOKUP's, how to filter/add comments (NOT note) in spreadsheet) - Need to manually input
2. How familiar are they with creating formulas within Excel? (Need to manually input data, NOT copy/paste data into sheets with pre-built formulas)
3. Explain how they use data mining?
4. Are they comfortable working during EST time zone? *their hours are set hours, no changes*
5. Do they have reliable internet at home?
6. They have a quiet place to work at home remotely? *Extremely important*

Timeline to fill:
- Start by 9/29 if possible
- Offer extended by 9/18
- Interviews by 9/11/25-9/18 (1 to 2 IV's)
*Camera Ready/Teams Link/30-45 mins
- Approvals/Submissions/SL reviewed by 9/10

*** is seeking an analyst experienced in health care or health plan compliance monitoring and auditing to join our Credentialing and Payer Delegation team. This position supports the credentialing compliance monitoring program activities, auditing, data collection, trend analysis and meeting timeliness for delegated payer deliverables.

Assists in the preparation of deliverables for payer and internal audit requests
Assist with credentialing tasks as needed
Building and maintaining effective, positive internal and external customer relationships
Conducting ongoing monitoring to evaluate levels of regulatory credentialing and delegated payer compliance with contractual and requirements
Exhibiting Client Heart at Work Behaviors
Participating in team initiatives and projects and meeting deadlines and quality expectations
Participates in the development and ongoing implementation of quality improvement activities. Improve quality products and services, by using measurements and analysis to process, evaluate and make recommendations to meet QM compliance objectives
Performing credentialing business process functions as needed, performing scheduled and random credentialing file audits
Reviewing risk assessments while participating in ongoing monitoring and annual program evaluation and identification of areas where there can be process improvement

Experience:
-3 years of related health care or health plan experience in credentialing compliance,
auditing, and quality assurance
-Proficient in Microsoft Office Applications; Excel, Outlook, Word, and Teams
-The ability to create spreadsheets, analyze data and identify trends.
-Strong attention to detail and the ability to multi-task in a fast-paced environment
-MDStaff experience is preferred

Education:
-Bachelor s Degree (preferred)

Position Summary:

*** is seeking an analyst experienced in health care or health plan compliance monitoring and auditing to join our Credentialing and Payer Delegation team. This position supports the credentialing compliance monitoring program activities, auditing, data collection, trend analysis and meeting timeliness for delegated payer deliverables.

Participates in the development and ongoing implementation of quality improvement activities. Improve quality products and services, by using measurements and analysis to process, evaluate and make recommendations to meet QM compliance objectives
Conducting ongoing monitoring to evaluate levels of regulatory credentialing and delegated payer compliance with contractual and requirements
Performing credentialing business process functions as needed, and credentialing documentation audits
Assist with credentialing tasks as needed
Reviewing risk assessments while participating in ongoing monitoring and annual identification of areas where there can be process improvement
Building and maintaining effective, positive internal and external customer relationships
Participating in team initiatives and projects and meeting deadlines and quality expectations
Exhibiting Client Heart at Work Behaviors

Experience:
2 years experience with NCQA compliance
1 year MDStaff experience.
3 years of related health care or health plan experience in credentialing compliance,
auditing, and quality assurance
Proficient in Microsoft Office Applications; Excel, Outlook, Word, and Teams
The ability to create spreadsheets, analyze data and identify trends.
Strong attention to detail and the ability to multi-task in a fast-paced environment
MDStaff experience is preferred
Independent time management in a work from home environment

Education:
Bachelor s Degree (preferred)

Duties:

*** is seeking an analyst experienced in health care or health plan credentialing, compliance monitoring and auditing to join our Credentialing and Payer Delegation team. This position supports the credentialing compliance monitoring program activities, auditing, data collection, trend analysis and meeting timeliness for delegated payer deliverables.

Assists in the preparation of deliverables for payer and internal audit requests
Communicating professionally and respectfully in all forms of interaction
Works independently and meet deadlines with high quality and accuracy
Assist with credentialing tasks and collaborative projects as needed
Building and maintaining effective, positive internal and external customer relationships
Conducting ongoing monitoring to evaluate levels of regulatory credentialing and delegated payer compliance with contractual and requirements
Exhibiting Client Heart at Work Behaviors
Participating in team initiatives and projects and meeting deadlines and quality expectations
Participates in the development and ongoing implementation of quality improvement activities. Improve quality products and services, by using measurements and analysis to process, evaluate and make recommendations to meet QM compliance objectives
Performing credentialing business process functions as needed, performing scheduled and random credentialing file audits
Reviewing risk assessments while participating in ongoing monitoring and annual program evaluation and identification of areas where there can be process improvement

Experience:

3 years of related health care or health plan experience in credentialing compliance,
auditing, and quality assurance
The ability to read, write, understand and apply written and verbal instructions with minimal assistance afterwards.
Proficiency in Microsoft Office Applications; Excel, Outlook, Word, and Teams
The ability to review, analyze, update data on shared spreadsheets and identify trends.
Strong attention to detail and the ability to multi-task in a fast-paced environment
MDStaff experience is preferred

Education:

Bachelor Degree (preferred)