A large healthcare insurance company is looking to hire a Quality Management Credentialing Analyst to their Final Optical Check Quality Management team. This person will work alongside the credentialing team and Board Committee to develop and update policies, audit and review processes, and assist in building out a strong provider base in both the physical and behavioral health field. Responsibilities include developing, implementing, and facilitating the regulatory and accreditation credentialing investigation process. They will Identify and analyze the credentialing processes for high-risk, high-volume and problem prone credentialing processes to mitigate risk and improve provider satisfaction. This person will use their previous credentialing background to recommend a plan of corrective action for resolution and follows up for adverse trends identified via data analysis. They will follow NCQA accreditation, CMS state and federal laws/regulations as well as internal policies
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-3-5 years of experience in credentialing, supporting either a Medical Staff Office or Provider Enrollment team
-Working experience/Knowledge of NCQA and CMS standard
-HS Diploma
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.