CREDENTIALING COMPLIANCE ANALYST

COOPER PEDIATRICS; Camden (NJ); On-site; USD 75,000 - 105,000; Full time

Job summary

Cooper University Health Care in New Jersey seeks a Compliance Analyst to support provider enrollment credentialing by auditing files and ensuring compliance with NCQA and The Joint Commission standards.

The analyst will audit 100% of credentialing and recredentialing submissions, verify data in the credentialing database for completeness and accuracy, and serve as a subject matter expert and coach for Credentialing Analysts. Proficiency with Excel and Word is required.

Qualifications

• Computer spreadsheet, database, and audit software literacy.
• Analytical skills, ability to define problems, collect data, establish facts, and draw valid conclusions.
• Strong written and verbal communication. Proficiency in application of audit theory, standards, procedures and techniques.
• Ability to interpret and apply department policies and procedures.

Responsibilities

• Audit 100% of credentialing and recredentialing files to ensure compliance with NCQA, The Joint Commission and other regulatory standards.
• Audit data entered in the Credentialing database for completeness, accuracy, consistency, and gaps.
• Perform follow-up activities related to audit errors to ensure corrections are made; serve as SME and coach for Credentialing Analysts.

Skills

Spreadsheet literacy

Analytical skills

Strong communication

Audit procedures

Education

High School Diploma

Bachelor's degree preferred

Tools

Microsoft Office

Excel

Word

Audit software

Job description

About us

AtCooper University Health Care, our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols. We have a commitment to our employees to provide competitive rates and compensation programs. Cooper offers full and part-time employees a comprehensive benefits program, including health, dental, vision, life, disability, and retirement. We also provide attractive working conditions and opportunities for career growth through professional development.

Discover why Cooper University Health Care is the employer of choice in South Jersey.

Short Description

Provide key support and analysis to the provider enrollment credentialing process which directly impact the ability of CUHC to bill for services rendered by billable providers, thereby directly impacting CUHC revenue generation for providers.

The framework for provider enrollment credentialing includes compliance in an increasingly complex regulatory environment defined by The Joint Commission, Department of Health, National Committee for Quality Assurance and Centers for Medicare and Medicaid standards.

The Compliance Analyst will audit 100% of credentialing and reappointment (recredentialing) files submitted by Credentialing Analysts to ensure compliance with National Committee for Quality Assurance (NCQA), The Joint Commission (TJC) accreditation and other regulatory standards, internal policies and procedures and managed care plan requirements.

The Analyst will also audit data entered in the Credentialing database for completeness, accuracy, consistency, gaps, etc.

This position will perform all necessary follow-up activities related to audit errors to ensure that corrections have been made appropriately and will serve as subject matter expert and coach for the Credentialing Analysts.

Experience Required

Computer spreadsheet, database, and audit software literacy.

Analytical skills, ability to define problems, collect data, establish facts, and draw valid conclusions.

Strong written and verbal communication. Proficiency in application of audit theory, standards, procedures and techniques.

Ability to interpret and apply department policies and procedures. 5+ years of experience in healthcare or managed care environment and/or related experience.

Education Requirements

High School Diploma Required

Bachelors Degree Preferred

Special Requirements

Ability to interact and work well with others.

Proficiency with Microsoft Office applications (Excel, Word).