Credentialing Quality & Compliance Analyst

Johns Hopkins Medicine; Hanover (MD); On-site; USD 40,000 - 66,000; Full time

Job summary

Johns Hopkins Medicine invites you to join the Quality Management Analyst – Credentialing & Legal Appeals role within the Johns Hopkins Health Plans team. You will manage high-risk credentialing files, ensure accuracy, and support compliance and timely completion of activities across credentialing and legal appeals.

You will coordinate meetings with SCR C chair, board members, and counsel; prepare and present reports; develop risk assessment packets; and schedule hearings, creating agendas and

Qualifications

• 3 years of experience in a managed care, business or healthcare environment with data analysis, reporting and meeting coordination.
• 5 years of experience in a managed care, business or healthcare environment with data analysis, reporting and project coordination.
• Knowledge of credentialing principles, methods, and procedures, typically through at least 3 years in credentialing.
• Experience managing challenging rejected provider applications in a credentialing environment (CVO, MCO, HMO, MSO).
• Certification in CPMSM or CPCS is preferred but not required.

Responsibilities

• Coordinate meetings with the SCR C chair, board members, and legal counsel.
• Create, prepare, and present reports to the SCR.
• Develop risk assessment packets for review.
• Prepare additional reports and schedule/attend legal meetings and appeal hearings, including agendas and minutes.
• Engage with attorneys, medical directors, and healthcare providers to support credentialing quality and risk management.

Skills

Data analysis

Reporting

Meeting coordination

Project coordination

Stakeholder communication

Education

Associate's degree

Bachelor's degree

Job description

Johns Hopkins Medicine invites you to join the Quality Management Analyst – Credentialing & Legal Appeals role within the Johns Hopkins Health Plans team. You will manage high-risk credentialing files, ensure accuracy, and support compliance and timely completion of activities across credentialing and legal appeals.

You will coordinate meetings with SCR C chair, board members, and counsel; prepare and present reports; develop risk assessment packets; and schedule hearings, creating agendas and