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AtlantiCare · 1 month ago

Credentialing Compliance Analyst

Atlantic City, NJ, 08401, United States

Full-time

Onsite

Mid, Senior Level

5+ years exp

AtlantiCare is a healthcare organization seeking a Credentialing Compliance Analyst. The role involves providing support and analysis to the provider enrollment credentialing process, auditing credentialing files, and ensuring compliance with various regulatory standards.

CRMFitnessHealth CareInformation Technology

Responsibilities

Provide key support and analysis to the provider enrollment credentialing process which directly impact the ability of AtlantiCare to bill for services rendered by billable providers, thereby directly impacting AtlantiCare revenue generation for providers

Audit 100% of credentialing and reappointment (re-credentialing) files submitted by Credentialing Specialists to ensure compliance with National Committee for Quality Assurance (NCQA), The Joint Commission (TJC) accreditation and other regulatory standards, internal policies and procedures and managed care plan requirements

Audit data entered in the Credentialing database for completeness, accuracy, consistency, gaps, etc

Perform all necessary follow-up activities related to audit errors to ensure that corrections have been made appropriately and will serve as subject matter expert and coach for the Credentialing Specialists

Support organizational goals by providing quality customer service, participating in performance improvement efforts and demonstrating a commitment to teamwork and cooperation

Qualification

Healthcare experienceAudit software literacyAnalytical skillsDatabase proficiencySpreadsheet proficiencyWritten communicationVerbal communicationTeamwork