Credentialing Compliance Analyst

POSITION SUMMARY

You will provide key support and analysis to the provider enrollment credentialing process, impacting AtlantiCare's revenue generation through accurate billing for services rendered by billable providers.

RESPONSIBILITIES

• Audit 100% of credentialing and reappointment files submitted by Credentialing Specialists to ensure compliance with NCQA, TJC accreditation, and other regulatory standards.
• Audit data entered in the Credentialing database for completeness, accuracy, consistency, gaps, etc.
• Perform follow-up activities related to audit errors to ensure appropriate corrections have been made.
• Serve as a subject matter expert and coach for Credentialing Specialists.

QUALIFICATIONS

• Education: Bachelor’s degree preferred.
• Licenses/Certifications: Not specified.
• Experience: 5 years in healthcare or managed care environment and/or related experience.
• Experience: Computer spreadsheet, database, and audit software literacy.
• Skills: Analytical skills, ability to define problems, collect data, establish facts, and draw valid conclusions. Strong written and verbal communication. Proficiency in 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. Some standing and walking may be required. Occasional lifting up to 20 pounds may be necessary.

REPORTING RELATIONSHIP

This position reports to Department Leadership.

TOTAL REWARDS

Total Rewards 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, and vision insurance
• Retirement plans with employer contributions
• Short-term and long-term disability coverage
• Life and 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.

Pay Transparency: In order to support the Fair Compensation Strategy by the US Govt., HR Dept., clients are required to adhere to "Pay Transparency Law" in impacted states, which mandate employers to list salary ranges in job advertisements and promotions.

AtlantiCare is an Equal Opportunity Employer.