Provider Credentialing - QC Analyst

Integrated Resources, Inc

Please note: Actual location may vary., RI

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JOB DETAILS

SKILLS

Analysis Skills, Auditing, Business Processes, Communication Skills, Contract Requirements, Customer Relations, Data Analysis, Data Collection, Data Entry, Datasheets, Detail Oriented, Documentation, Documentation Review, Establish Priorities, File Audits, Health Plan, Healthcare, Internal Audit, Maintain Compliance, Microsoft Excel, Microsoft Outlook, Microsoft Word, Multitasking, Process Improvement, Program Evaluation, Provider Credentialing, Public/Media/Press/Analyst Relations, Quality Assurance, Quality Control, Quality Management, Regulations, Risk Analysis, Spreadsheets, Time Management, Trend Analysis, Vlookups

LOCATION

Please note: Actual location may vary., RI

POSTED

3 days ago

Client bill rate max ***
Supplier bill rate ***

*Safety Sensitive*

Screening Questions:
Notate city/state at top of resume
1. Excel is required - what experience do they have using MS Excel? (Need to know VLOOKUP's, how to filter/add comments (NOT note) in spreadsheet) - Need to manually input
2. How familiar are they with creating formulas within Excel? (Need to manually input data, NOT copy/paste data into sheets with pre-built formulas)
3. Explain how they use data mining?
4. Are they comfortable working during EST time zone? *their hours are set hours, no changes*
5. Do they have reliable internet at home?
6. They have a quiet place to work at home remotely? *Extremely important*

Timeline to fill:
- Start by 7/27 if possible
- Offer extended by 7/17
- Interviews by 7/9/26-7/18 (1 to 2 IV's)
*Camera Ready/Teams Link/30-45 mins
- Approvals/Submissions/SL reviewed by 7/20

*** is seeking an analyst experienced in health care or health plan compliance monitoring and auditing to join our Credentialing and Payer Delegation team. This position supports the credentialing compliance monitoring program activities, auditing, data collection, trend analysis and meeting timeliness for delegated payer deliverables.

" Assists in the preparation of deliverables for payer and internal audit requests
" Assist with credentialing tasks as needed
" Building and maintaining effective, positive internal and external customer relationships
" Conducting ongoing monitoring to evaluate levels of regulatory credentialing and delegated payer compliance with contractual and requirements
" Exhibiting Client Heart at Work Behaviors
" Participating in team initiatives and projects and meeting deadlines and quality expectations
" Participates in the development and ongoing implementation of quality improvement activities. Improve quality products and services, by using measurements and analysis to process, evaluate and make recommendations to meet QM compliance objectives
" Performing credentialing business process functions as needed, performing scheduled and random credentialing file audits
" Reviewing risk assessments while participating in ongoing monitoring and annual program evaluation and identification of areas where there can be process improvement

Experience:
-3+ years of related health care or health plan experience in credentialing compliance,
auditing, and quality assurance
-Proficient in Microsoft Office Applications; Excel, Outlook, Word, and Teams
-The ability to create spreadsheets, analyze data and identify trends.
-Strong attention to detail and the ability to multi-task in a fast-paced environment
-MDStaff experience is preferred

Education:
-Bachelor s Degree (preferred)

Position Summary:

*** is seeking an Analyst experienced in compliance monitoring and auditing to join our Credentialing and Payer Delegation team. This position supports the credentialing compliance monitoring program activities and deliverables. The position is responsible for:
" Creating spreadsheets with formulas to track and trend data
" Developing and maintaining an in-depth working knowledge of contractual, regulatory, and program policy related obligations
" Participates in the development and ongoing implementation of quality improvement activities. Improve quality products and services, by using measurements, data and trend analysis to process, evaluate and make recommendations to meet credentialing QM compliance objectives
" Conducting ongoing monitoring to evaluate levels of regulatory credentialing and delegated payer compliance with contractual and requirements
" Performing business process and credentialing documentation reviews and audits
" Building and maintaining effective, positive internal and external customer relationships
" Professional and clear communication and presentation of findings
" Working with minimal supervision and able to effectively manage and prioritize multiple projects simultaneously

Duties:

Developing and maintaining an in-depth working knowledge of contractual, regulatory, and program policy related obligations
Participates in the development and ongoing implementation of quality improvement activities. Improve quality products and services, by using measurements and analysis to process, evaluate and make recommendations to meet QM compliance objectives
Conducting ongoing monitoring to evaluate levels of regulatory credentialing and delegated payer compliance with contractual and requirements
Performing business process and credentialing documentation audits
Reviewing risk assessments while participating in ongoing monitoring and annual identification of areas where there can be process improvement

Experience:

3+ years of related health care or health plan experience in credentialing compliance,
auditing, and quality assurance

Education:

Bachelor Degree is Preferred

About the Company

Integrated Resources, Inc

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