Analyst, Physician Credentialing
5 days ago
Provider Credentialing Analyst
ArchWell Health is a new, innovative healthcare provider devoted to improving the lives of our senior members. We deliver best-in-class care at comfortable, accessible neighborhood clinics where seniors can feel at home and become part of a vibrant, wellness-focused community. Our members experience greater continuity of care, as well as the comfort of knowing they will be treated with respect by people who genuinely care about them, their families, and their communities.
Job Summary: Reporting to the Director of Provider Credentialing, the Provider Credentialing Analyst is responsible for credentialing new providers and maintaining current provider files for our quickly growing medical group. This hire will partner with current credentialing staff and own the end-to-end credentialing process, including: submitting and tracking credentialing applications to various contracted managed care plans and government payors for oncoming providers; maintaining the data for all providers within the group; tracking the expiration of certification and licenses; and will act as a liaison between payors, external credentialing service firms, and medical staff, including physicians.
Duties/Responsibilities
- Build the ArchWell Health credentialing workplan and processes, including all required credentialing for providers and facilities as dictated by government payors and contracted managed care plans
- Complete all necessary credentialing and enrollment workflows for providers and facilities, including, but not limited to
oData collection and primary source verification
oEnsure providers are credentialed in a timely manner by monitoring and maintaining the end-to-end submission process for assigned payor contracts
oOwn all payor reporting, including data reporting and monthly exclusion checks
oOversee ongoing renewals for all required provider licenses and credentials
- Assist in building out new payor operations as new contracts are executed
- Act as a liaison between government payors and managed care plans, outsourced credentialing services, and ArchWell Health medical staff, including providers
- Other projects and tasks as assigned
Required Skills/Abilities:
- Must understand Medicare, Medicaid, and managed care plan credentialing requirements and must be familiar with CAQH (Council for Affordable Quality Healthcare)
- Must also be able to work/communicate with providers in a professional manner to assist in the completion of the CAQH applications
- Knowledge of medical terminology, strong organization skills, good written communication skills, ability to work independently, and ability to conduct research while performing job duties
- Tech savvy and willing to learn CredentialStream
- Must have excellent communication skills to effectively communication with all levels of staff including internal and external stakeholders
- Must be detail oriented Education and Experience:
- Location: Remote
- Bachelor's degree preferred
- At least three (3) years of medical credentialing and enrollment experience
- Proficient PC skills
- Embodies and serves as a role model of ArchWell Health's Values:
o Be compassionate
o Strive for excellence
o Earn trust
o Show respect
o Stay resilient
o Always do the right thing
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