Analyst, Physician Credentialing

ArchWell Health; Nashville (TN); On-site; USD 60,000 - 75,000; Full time

Job summary

ArchWell Health is seeking a Provider Credentialing Analyst to own end-to-end credentialing for new providers and ongoing enrollment with government payors and managed care plans. Remote work; collaborate with credentialing staff to maintain provider data and licensure renewals.

You will manage primary source verification, CAQH applications, and payor reporting, acting as the liaison between payors, external services, and ArchWell Health medical staff to ensure timely credentialing.

Qualifications

• Bachelor’s degree preferred with at least three years of medical credentialing and enrollment experience.
• Experience with Medicare/Medicaid credentialing and enrollment processes.
• Familiarity with CAQH and CAQH applications.

Responsibilities

• Build credentialing workplans and processes for providers and facilities.
• Complete credentialing and enrollment workflows including primary source verification and data collection.
• Own payor reporting and monthly exclusion checks.
• Oversee renewals for licenses and credentials.
• Serve as liaison between payors, credentialing services, and medical staff.
• Handle other projects as assigned.

Skills

Medicare/Medicaid

CAQH familiarity

Professional communication

Medical terminology

Organizational skills

Independent work

Research skills

CredentialStream

Education

Bachelor’s degree preferred

Tools

CredentialStream

Job description

Provider Credentialing Analyst

ArchWell Health is a new, innovative healthcare provider devoted to improving the lives of our senior members. We deliver best-in-class care at comfortable, accessible neighborhood clinics where seniors can feel at home and become part of a vibrant, wellness-focused community. Our members experience greater continuity of care, as well as the comfort of knowing they will be treated with respect by people who genuinely care about them, their families, and their communities.

Job Summary: Reporting to the Director of Provider Credentialing, the Provider Credentialing Analyst is responsible for credentialing new providers and maintaining current provider files for our quickly growing medical group. This hire will partner with current credentialing staff and own the end-to-end credentialing process, including: submitting and tracking credentialing applications to various contracted managed care plans and government payors for oncoming providers; maintaining the data for all providers within the group; tracking the expiration of certification and licenses; and will act as a liaison between payors, external credentialing service firms, and medical staff, including physicians.

Duties/Responsibilities

• Build the ArchWell Health credentialing workplan and processes, including all required credentialing for providers and facilities as dictated by government payors and contracted managed care plans
• Complete all necessary credentialing and enrollment workflows for providers and facilities, including, but not limited to
  • Data collection and primary source verification
  • Ensure providers are credentialed in a timely manner by monitoring and maintaining the end-to-end submission process for assigned payor contracts
  • Own all payor reporting, including data reporting and monthly exclusion checks
  • Oversee ongoing renewals for all required provider licenses and credentials
• Assist in building out new payor operations as new contracts are executed
• Act as a liaison between government payors and managed care plans, outsourced credentialing services, and ArchWell Health medical staff, including providers
• Other projects and tasks as assigned

Required Skills/Abilities

• Must understand Medicare, Medicaid, and managed care plan credentialing requirements and must be familiar with CAQH (Council for Affordable Quality Healthcare)
• Must also be able to work/communicate with providers in a professional manner to assist in the completion of the CAQH applications
• Knowledge of medical terminology, strong organization skills, good written communication skills, ability to work independently, and ability to conduct research while performing job duties
• Tech savvy and willing to learn CredentialStream
• Must have excellent communication skills to effectively communication with all levels of staff including internal and external stakeholders
• Must be detail oriented

Education and Experience

• Location: Remote
• Bachelor’s degree preferred
• At least three (3) years of medical credentialing and enrollment experience
• Proficient PC skills

Embodies and serves as a role model of ArchWell Health’s Values

• Be compassionate
• Strive for excellence
• Earn trust
• Show respect
• Stay resilient
• Always do the right thing