Credentialing Quality Analyst

Job Summary

To support credentialing quality and risk management processes, the full-time Credentialing Quality Analyst will manage high-risk credentialing files, ensure compliance and accuracy, and coordinate meetings and reports remotely.

Key responsibilities

• Coordinate meetings with the Special Credentials Review Committee and prepare reports for presentation
• Develop risk assessment packets and manage the scheduling of legal meetings and appeal hearings
• Analyze data and documentation to identify errors and inconsistencies in credentialing processes

Required qualifications

• 3-5 years of experience in a managed care, business, or healthcare environment with skills in data analysis and reporting
• Thorough knowledge of provider credentialing principles and procedures, typically acquired through credentialing experience
• Associates degree required; Bachelor's degree preferred in a related field
• Certification as CPMSM or CPCS is preferred but not required
• Experience managing challenging healthcare provider applications in a credentialing environment