Credentialing Analyst

QualChoice

(Arkansas 300)
Full Time
Job Posting Details
About QualChoice
QualChoice Health Insurance is your trusted partner in providing the best value in health benefits for your employees or customers — or for you and your family. Our friendly, personal service and track record of treating people right are one reason we’re the quality choice for health insurance in Arkansas.
Summary
This position is responsible for analyzing the credentials of physicians and other health care providers to ensure the quality of provider network data.
Responsibilities
* Conducts primary verification activities to be in compliance with URAC. * Serves as interdepartmental liaison for problem resolution for issues that relate to the credentialing or re-credentialing of the provider network. * Maintains the credentialing management system (Cactus) on a daily basis to track and update the recruitment, credentialing, and re-credentialing information. * Compiles and coordinates credentialing and re-credentialing information, computerized and hard copy, for presentation to the Credentials Committee. * Responsible for Provider Credentialing Notification process and biweekly reporting. * Attends Arkansas State Medical Board Meetings when Senior Credentialing Coordinator is unavailable. * Other duties as assigned. * Conducts business with high regard for corporate values and in compliance with its Code of Business Conduct. * Maintains high regard for member privacy and complies with information security and HIPAA policies. * Responsible for quality and continuous improvement within the job scope. Contributes to and supports the company’s quality initiatives. * Accountable for all actions/responsibilities described in the company’s policies and procedures as they relate to this position.
Ideal Candidate
* Ability to maintain confidentiality * Excellent organizational skills to effectively prioritize workload. * Ability to assume responsibility and work independently. * Ability to apply established credentialing criteria against documentation. * Strong written and verbal communication skills. * Keen attention to detail. * Must have strong skills in Microsoft Word, Excel and Access. * Must have high school diploma or equivalent. * Prefer an associate’s degree. * Prefer at least one year of credentialing and/or provider relations experience or equivalent work experience.

Questions

Answered by on
This question has not been answered
Answered by on

There are no answered questions, sign up or login to ask a question

Want to see jobs that are matched to you?

DreamHire recommends you jobs that fit your
skills, experiences, career goals, and more.