Analyst, Physician Credentialing

ArchWell Health; United States; Remote; USD 65,000 - 90,000; Full time

Job summary

ArchWell Health is seeking a Provider Credentialing Analyst to own the end-to-end credentialing process for new and existing providers. You will submit and track applications with contracted payors and government payors, maintain provider data, and monitor license and certification expirations.

Reporting to the Director of Provider Credentialing, you will partner with credentialing staff and serve as a liaison between payors, external firms, and medical staff to ensure timely credentialing and

Qualifications

• Must understand Medicare, Medicaid, and managed care credentialing requirements.
• Familiar with CAQH (Council for Affordable Quality Healthcare).
• Ability to work with providers to complete CAQH applications professionally.
• Knowledge of medical terminology; strong organization and research skills.
• Tech savvy and willing to learn CredentialStream.
• Excellent written and verbal communication with all levels of staff.

Responsibilities

• Build ArchWell Health credentialing workplan and processes per payor requirements.
• Complete credentialing and enrollment workflows for providers and facilities.
• Data collection and primary source verification.
• Monitor end-to-end submission process for payor contracts.
• Own payor reporting and monthly exclusion checks.
• Oversee renewals for licenses and credentials.
• Liaise between payors, credentialing services, and medical staff.

Skills

Medicare/Medicaid credentialing

CAQH familiarity

Professional communication

Data collection & verification

CredentialStream

Research and documentation

Attention to detail

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
  
  
  
  • oData collection and primary source verification
  
  
  • oEnsure providers are credentialed in a timely manner by monitoring and maintaining the end-to-end submission process for assigned payor contracts
  
  
  • oOwn all payor reporting, including data reporting and monthly exclusion checks
  
  
  • oOversee 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:
  
  
  
  • o Be compassionate
  
  
  • o Strive for excellence
  
  
  • o Earn trust
  
  
  • o Show respect
  
  
  • o Stay resilient
  
  
  • o Always do the right thing