Credentialing & Legal Appeals Quality Analyst

Johns Hopkins Health Plans; Washington (District of Columbia, MD); Sur place; USD 40 000 - 66 000; Plein temps

Résumé du poste

Johns Hopkins Health Plans is seeking a Quality Management Analyst for Credentialing & Legal Appeals to manage high-risk credentialing files, ensure accuracy, compliance, and timely completion. The role reports to the Credentialing Supervisor and interacts with attorneys, medical directors, and providers.

Responsibilities include coordinating meetings with the SCR C chair and board, preparing reports, developing risk assessment packets, scheduling legal meetings and hearings, and creating

Qualifications

• Requires 3 years of experience in a managed care, business or healthcare environment with proven skills in data analysis, reporting and meeting coordination.
• Minimum 5 years of experience in a managed care, business or healthcare environment with proven skills in data analysis, reporting and project coordination.
• Requires thorough knowledge of provider credentialing principles, methods, and procedures, typically acquired through a minimum of three (3) years of credentialing experience. Demonstrated experience managing the process of challenging rejected healthcare provider applications in a managed care credentialing environment is required, such as a Credentials Verification Organization (CVO), Managed Care Organization (MCO), Health Maintenance Organization (HMO), or hospital-based credentialing setting (MSO).

Responsabilités

• Coordinate meetings with the Chairman of the SCR C and with board members and legal counsel.
• Create, prepare, and present reports to the SCR C.
• Develop risk assessment packets for review.
• Prepare additional reports as needed.
• Schedule and attend legal meetings and appeal hearings and create meeting agendas and minutes.
• Manage a demanding workload while meeting strict deadlines.

Connaissances

Data analysis

Reporting

Meeting coordination

Project coordination

Attention to detail

Formation

Associates degree required

Bachelor’s degree preferred

Certified Coder (CPC) preferred

Description du poste

Johns Hopkins Health Plans is seeking a Quality Management Analyst for Credentialing & Legal Appeals to manage high-risk credentialing files, ensure accuracy, compliance, and timely completion. The role reports to the Credentialing Supervisor and interacts with attorneys, medical directors, and providers.

Responsibilities include coordinating meetings with the SCR C chair and board, preparing reports, developing risk assessment packets, scheduling legal meetings and hearings, and creating