Physician Credentialing Analyst

Vitas Healthcare Corporation; Florida; On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

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Job summary

The Physician Credentialing Analyst is a pivotal role at Vitas Healthcare Corporation, supporting credentialing and re-credentialing compliance with a focus on Medicaid and Medicare provider enrollments.

The analyst analyzes compliance with internal policies and external standards, prepares organization-wide reports, and attends on-site meetings at the corporate Miramar, Florida office to ensure accurate documentation and timely credentialing workflows.

Qualifications

• Bachelor’s degree in Business Administration or related field preferred.
• Previous credentialing compliance experience required.
• Ability to maintain confidentiality and handle confidential information.
• Detail oriented with good organizational skills.
• Ability to work independently and communicate effectively with stakeholders.

Responsibilities

• Coordinate collection of physician documentation to ensure timely credentialing.
• Develop and deliver standard and ad hoc reports, dashboards, and metrics.
• Prepare analyses and presentations for management on credentialing activities.
• Maintain accurate, up-to-date credentialing databases.
• Attend on-site meetings at the Miramar, Florida office.
• Collaborate with Risk Management and Legal to avoid compliance issues.
• Explain credentialing processes to program staff and vendors.

Skills

Organizational skills

Analytical skills

Problem solving

MS Office

Communication skills

Confidentiality

Education

Bachelor's degree in Business Administration

Tools

Outlook

Excel

Word

Job description

The Physician Credentialing Analyst is responsible for supporting the organization’s credentialing and re-credentialing compliance programs, with a focus on Medicaid and Medicare provider enrollments. Provides analyses and reporting for the organization wide administration of the credentialing and re-credentialing compliance function. Evaluates and reports on compliance standards with internal policies and procedures and external vendor credentialing standards. Must be able to attend meetings on-site at the Corporate Miramar, Florida office.

• Brings to the attention of internal management any issues which could cause the organization potential losses due to adverse legal action or risk irregularities.
• Collects physician related documentation from programs to ensure credentialing process is coordinated accurately and timely in compliance with defined schedules.
• Conducts studies, performs research and prepares reports.
• Confers with Risk Management Department and Legal Department as needed to avoid potential compliance issues.
• Develop standard and ad hoc reports, templates, dashboards, scorecards, and metrics.
• Maintains accurate and up-to-date computerized database.
• Meet with management to discuss and clarify requests for projects, highlight issues, and make recommendations to address issues and priorities.
• Performs data analysis and utilizes results to create reports and presentations.
• Safeguards the integrity of the credentialing administration function by exercising good judgment, and sharing best practices among the programs.
• Serves as subject matter expert in the credentialing compliance function. Confers with program management and staff. Provides guidance to ensure proper documentation meets internal and external compliance standards.
• Serves as subject matter expert in the credentialing compliance function.
• Write detailed reports and make oral presentations to management.

Qualifications

• Organizational, analytic, and problem solving skills
• Personal computer skills with knowledge of MS software
• Previous credentialing compliance experience required.
• Ability to maintain confidentiality and handle confidential information.
• Detail oriented with good organization skills.
• Ability to work independently.
• Ability to communicate, both verbally and in writing, with internal and external customers in a professional, courteous manner.
• Ability to communicate tactfully, verbally and in writing with department heads, managers, coworkers and vendors to resolve problems and negotiate resolutions.
• Working knowledge of computers, internet access, and the ability to navigate within an automated systems as well as a variety of software packages such as Outlook, Excel and Word.

EDUCATION

• Bachelor’s degree in Business Administration or related field from an accredited college or university or the international equivalent preferred.

SPECIAL INSTRUCTIONS TO CANDIDATES

• EOE/AA M/F/D/V