Revenue Cycle Credentialing Analyst

About the role

Mountain Park Health Center is a non-profit, Community Health Center dedicated to strengthening the communities we serve through accessible, high-quality, and affordable healthcare. We provide a comprehensive array of services including Pediatrics, Women's Health, Internal Medicine, Dental care, Lab, and Pharmaceutical services across multiple clinics in the Valley.

Responsibilities

• Affords assistance in developing metrics to address late credentialing issues for Mountain Park Health Center providers.
• Maintains an accurate database of credentialing status for providers and plans.
• Coordinates with plans to ensure accurate provider rosters are maintained by plan.
• Completes and submits provider credentialing and re-credentialing applications to plans prior to providers starting work.
• Obtains AHCCCS and Medicare numbers for providers before they begin patient care.
• Holds plans accountable for credentialing new providers within the rules and timeframes set for Federally Qualified Health Centers (FQHC).
• Collaborates with billing to resolve credentialing and billing issues.
• Keeps abreast of Medicaid, Medicare, private health plans, and agency requirements for credentialing providers.
• Sets up and maintains provider information in CAQH databases and systems.
• Ensures that practice addresses and other critical information are updated with health plans, agencies, and other entities.
• Maintains plan information in the credentialing database using alert systems to proactively monitor credentialing deadlines.
• Creates a system to track and respond to communications from plans and credentialing requests promptly.
• Collaborates with Privileging and Human Resources (HR) to ensure that initial credentialing forms are submitted on time and accurately by new providers.
• Performs other duties as assigned.

Requirements

• Bachelor’s degree and two years of credentialing experience, or four years of credentialing experience if a bachelor’s degree is not held.
• Possession of a Certified Provider Credentialing Specialist (CPCS) certification is preferred.