Credentialing Analyst CVO-Staff Credentialing

Summary:

The Credentialing Analyst is responsible for leading, coordinating, monitoring, analyzing, and maintaining the credentialing expirables processand overseeing the review and monitoring of sanctions and disciplinary actions. Ensures compliance with accrediting and regulatory agencies by developing and maintaining a thorough understanding of relevant statutes, laws, and industry standards. Continuously monitors and ensures that the credentialing process aligns with current legal requirements, including regular review of provider sanctions. Accountable for maintaining the accuracy, integrity, and confidentiality of data within the credentialing database, ensuring timely updates, and reporting as needed.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Conducts thorough investigation, research, and primary source verification of all expirable.
• Identifies issues that require additional investigation and evaluation, validates discrepancies, and ensures appropriate follow-up.
• Prepares and sends monthly expirable reports to clients.
• Meets weekly performance metrics which includes amount of expirable completed and data integrity.
• Utilizes and maintains the credentialing database, optimizing efficiency, and performs queries, reports, and document generation.
• Monitors the initial, reappointment, and expirable process for practitioners, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, Federal/State), bylaws, policies/procedures, and delegated agreements
• Maintains strict confidentiality of all data and information.
• Monitors and reviews sanctions and disciplinary actions, ensuring compliance, timely follow-up, and accurate documentation in the credentialing process.
• Maintain accurate and up-to-date practitioner data within credentialing systems, adhering to established guidelines and procedures.
• Utilize credentialing systems to efficiently manage and enhance the credentialing process.
• Ensure data accuracy and integrity through attention to detail and adherence to established standards.
• Maintain a comprehensive understanding of accreditation, certification, and credentialing/privileging procedures to ensure compliance with regulatory requirements.
• Performs miscellaneous job-related duties as assigned.

Job Requirements:

Education/Skills

• High School Diploma or GED required

Experience

• 1 year of experience related to hospital or managed care credentialing required

Licenses, Registrations, or Certifications

• Certified Provider Credentialing Specialist (CPCS) preferred

Work Schedule:

TBD

Work Type:

Full Time

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