Credentialing Compliance Analyst

Cooper University Health Care; Camden (NJ); On-site; USD 43,000 - 73,000; Full time

Job summary

Cooper University Health Care in Camden, NJ seeks a Compliance Analyst to support provider enrollment credentialing, ensuring regulatory alignment and revenue integrity. You will audit credentialing and recredentialing files, verify data in the Credentialing database, and coach analysts to uphold standards.

Qualifications include 5+ years in healthcare or managed care, strong analytical and communication skills, and proficiency with Microsoft Office (Excel/Word).

Qualifications

• Bachelor's degree preferred; high school diploma required.
• 5+ years of experience in healthcare or managed care environment.
• Proficiency in Microsoft Office, especially Excel and Word.
• Strong analytical and problem-solving abilities.

Responsibilities

• Audit 100% of credentialing and recredentialing files for NCQA/TJC compliance.
• Audit data in the Credentialing database for completeness and accuracy.
• Address audit errors with follow-up actions and correctives.
• Serve as subject-matter expert and coach for Credentialing Analysts.

Skills

Analytical skills

Communication

Spreadsheet literacy

Audit software

Education

High School Diploma

Bachelor's Degree Preferred

Tools

Microsoft Excel

Microsoft Word

Database 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).

Salary Min ($)

USD $31.00

Salary Max ($)

USD $53.00