Credentialing Compliance Analyst

POSITION SUMMARY

In this role, you will 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.  The framework for provider enrollment credentialing includes compliance in an increasingly complex regulatory environment defined by The Joint Commission, Department of Health, and National Committee for Quality Assurance and Centers for Medicare and Medicaid standards.

The Compliance Analyst will 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.  The Analyst will also audit data entered in the Credentialing database for completeness, accuracy, consistency, gaps, etc.  This position will 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.

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

QUALIFICATIONS

EDUCATION:  Bachelor’s degree preferred.

LICENSE/CERTIFICATION:

EXPERIENCE:  5 years in healthcare or managed care environment and/or related experience. Experience with computer spreadsheet, database, and audit software literacy.  Analytical skills, ability to define problems, collect data, establish facts, and draw valid conclusions.  Strong written and verbal communication.  Proficiency in application of audit theory, standards, procedures and techniques.  Ability to interpret and apply department policies and procedures

PERFORMANCE EXPECTATIONS

Demonstrates the technical competencies as established on the Assessment and Evaluation Tool.

WORK ENVIRONMENT

This position requires desk/computer work.  This position requires some standing and walking and occasional lifting up to 20 pounds required. The essential functions for this position are listed on the Assessment and Evaluation Tool.

Essential functions of this position are listed on the Assessment and Evaluation Tool.

REPORTING RELATIONSHIP

This position reports to Department Leadership.

The above statement reflects the general details considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position.

Total Rewards at AtlantiCare

At AtlantiCare, we believe in supporting the whole person. Our market-competitive Total Rewards package is designed to promote the physical, emotional, social, and financial well-being of our team members. We offer a comprehensive suite of benefits and resources, including:

Generous Paid Time Off (PTO)

Medical, Prescription Drug, Dental & Vision Insurance

Retirement Plans with employer contributions

Short-Term & Long-Term Disability Coverage

Life & Accidental Death & Dismemberment Insurance

Tuition Reimbursement to support your educational goals

Flexible Spending Accounts (FSAs) for healthcare and dependent care

Wellness Programs to help you thrive

Voluntary Benefits, including Pet Insurance and more

Benefits offerings may vary based on position and are subject to eligibility requirements.

Join a team that values your well-being and invests in your future.