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Parkland Health · 1 week ago

Credentialing Analyst - Health Plan

Dallas, TX

Full-time

Onsite

Mid Level

3+ years exp

Parkland Health is seeking a Credentialing Analyst to support the credentialing program that ensures compliance with federal, state, and NCQA accreditation requirements. The role involves evaluating practitioners and facilities for entry into the network, analyzing provider data, and communicating with providers to address their inquiries.

CommunitiesHealth CareHospitalMedicalNon ProfitWellness

H1B Sponsor Likely

Responsibilities

Builds and maintains relationships with external vendors and credentialing partners including Aperture & Texas Association of Health Plans

Administrates reports in external database portals & analyze data, confirm accuracy, and present to internal department

Assists with the oversight of the delegated and non-delegated provider and facility's data

Gathers, analyzes, and reports provider data to internal and external customers

Ensures that all practitioners and facilities are evaluated upon entry into the PCHP network and conducts an ongoing review of the providers

Identifies opportunities for improvement through the audit process and provide recommendations

Accurately tracks, reports, and follows up on the status of credentialing applications

Maintains a strict degree of confidentiality in all areas relating to provider credentials, status and provider personal information

Familiar with state specific all credentialing department policies and procedures

Assist with miscellaneous audits projects throughout the year as required

Communicates with Credentialing Manager regarding any or all credentialing delays or issues

Other duties as assigned

Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of PCHP

Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices

Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding

Qualification

Credentialing experienceNCQA accreditationMicrosoft ExcelCAQHData analysisInterpersonal skillsAdobe ProMicrosoft OutlookSharePointProblem solvingTime managementCommunication skillsTeam collaboration

Required

Bachelors degree is required

3 years of managed care or credentialing experience

Advanced proficiency in Microsoft Excel to include VLOOKUP, creating complex function and equations

Proficiency in Adobe Pro and Microsoft Outlook

Strong interpersonal, problem solving and relationship building skills with positive attitude and demeanor

Ability to take initiative to research and form conclusions independently

Ability to manage multiple deadlines and time constraints in a fast-paced environment

Demonstrated ability to collaborate effectively and work as part of a team including internal and external stakeholders

Ability to perform detail work efficiently and with a high degree of accuracy

Clear and professional verbal and written communication skills with the ability to clearly explain complex processes

Skilled in interpreting, analyzing, and providing recommendations regarding data accuracy and data collection needs and processes

Excellent planning, organization, time management, and documentation skills

Preferred

Experience with CAQH, Texas Association of Health Plans (TAHP), NCQA accreditation, Aperture, or National Provider Data Bank (NPDB)

Experience with federal, state and/or local managed care statutes

Experience with managing provider data

National Association Medical Staff Services (NAMSS) certification

Experience using SharePoint

Company

Parkland Health

Parkland Health first opened its doors in 1894 and is now one of the largest public hospital systems in the country.

Founded in 1894

Dallas, Texas, USA

10001+ employees

https://www.parklandhealth.org

H1B Sponsorship

Parkland Health has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (2)

2024 (2)

2022 (2)