Network & Cred QA Analyst

1 month ago

Lombard, Illinois, United States Dearborn Group Full time

At Dearborn Group, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.

Come join us and be part of a purpose driven company who is invested in your future

Job Summary

Under supervision, this role is responsible for performing oversight on essential credentialing functions to attain and maintain quality providers in the dental network. This role also conducts audits for credentialing as well as network data quality. Understands credentialing policies and procedures per NCQA, URAC and CMS standards and other regulatory requirements. Serves as a liaison to delegated entities and vendors to ensure current and adequate credentialing process are in place. Develops and performs queries for data reporting purposes to include directories, ad hoc reports, and network management reports. Responsible for the monitoring and maintenance of credentialing and re-credentialing polies and program as well as state and federal requirements to ensure compliance is met. This role will provide operational and industry knowledge to ensure credentialing practices and pr

Required Job Qualifications:

  • Bachelor degree and 2 years of experience in accreditation programs (i.e., NCQA, URAC and CMS programs) or 6 years of experience in accreditation programs
  • Proficiency in accreditation program standards including NCQA, URAC and CMS
  • Knowledge of state and federal requirements for contracting and credentialing.
  • Attention to detail and ability to track information to defined quality standards
  • Knowledge of documents and their contents used in provider contracting, including applications, agreements, fee schedules, and credentialing.
  • Knowledge of provider contracting terms.
  • Analytical skills
  • Demonstrated experience understanding and maintaining detailed complex provider records.
  • Attention to detail and ability to enter data and meet defined quality standards
  • Experience balancing multiple priorities while meeting commitments for quality and delivery at agreed upon schedules.
  • Clear and concise verbal and written communication skills.
  • Proficient in Microsoft Office products, email and Internet.
  • Ability to work well in a team environment.

Preferred Job Qualifications:

  • Analytical skills
  • Knowledge of Dental industry
  • Auditing experience

THIS IS A FLEX ROLE WORKING 3 DAYS IN THE OFFICE AND 2 DAYS FROM HOME

#LI-HYBRID

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process

Dearborn Group Employment Statement:

Dearborn Group is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

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