Provider Data & Credentialing Analyst

University of California - Irvine Health; Orange (CA); On-site; USD 70,000 - 100,000; Full time

Job summary

UCI Health is seeking a Provider Data Analyst to maintain provider databases, prepare rosters, and ensure enrollment data accuracy for regulatory and payor reporting. You will work with billing teams to improve data integrity and resolve credentialing issues.

Ideal candidates have 5+ years in provider data, strong English communication, and advanced MS Office/EMR skills to support process improvements across departments.

Qualifications

• Proficiency in common database, spreadsheet and presentation software.
• Must possess the skill, knowledge and ability essential to the successful performance of assigned duties
• Must demonstrate customer service skills appropriate to the job
• Minimum of 5 years of relevant experience
• Excellent written and verbal communication skills in English
• Detail oriented, with demonstrated organizational skills and the ability to manage time efficiently, prioritize tasks, set schedules, and complete projects in a timely and cost-effective manner.
• Demonstrated communications skills, with the ability to interpret and convey complex clinical finance information in a clear, concise manner. Ability to summarize and present reports and presentations.
• Demonstrated analytical and problem-solving skills, with the ability to evaluate the effectiveness of workflows and systems.
• Bachelor's Degree in related area and/or equivalent education/experience
• Advanced knowledge of relevant healthcare regulations issued by Federal and State entities.
• Advanced knowledge of managed care, provider enrollment / credentialing, and / or medical staff operations. Working knowledge of the practices, procedures, and concepts of the healthcare enrollment cycle. Knowledge of any or all the following: billing, collections, contracts.
• Advanced knowledge and skill using MS Office applications, EMR systems, and credentialing software. Ability to set priorities and lead performance improvement projects.
• Advanced communication, conflict-management, and customer-service skills.
• Advanced ability to organize and prioritize assignments and workload.
• Advanced ability to maintain confidentiality and use discretion when handling sensitive medical staff issues.
• Advanced ability to interact with all levels of medical staff, including department chairs, division chiefs, and medical staff providers.
• Ability to maintain a work pace appropriate to the workload
• Ability to interpret health plan enrollment regulations to ensure compliance.
• Ability to establish and maintain effective working relationships across the Health System

Responsibilities

• Maintain database for hospital, group and billing providers and prepare rosters and reports
• Ensure accuracy of information and inclusion of all network providers
• Review and analyze provider data to prepare rosters and enrollments reports
• Meet regulatory requirements and third-party payor reporting criteria
• Collaborate with billing departments to ensure data integrity and research claim denials related to provider enrollment/credentialing
• Assist management in achieving department productivity and process improvement goals

Skills

Databases

Customer service

English communication

Detail oriented

Analytical thinking

Time management

Reporting

Problem solving

Interpreting complex data

Education

Bachelor's Degree in related area

Tools

MS Office

EMR systems

Credentialing software

MD-Staff software

SFTP (preferred)

Job description

UCI Health is seeking a Provider Data Analyst to maintain provider databases, prepare rosters, and ensure enrollment data accuracy for regulatory and payor reporting. You will work with billing teams to improve data integrity and resolve credentialing issues.

Ideal candidates have 5+ years in provider data, strong English communication, and advanced MS Office/EMR skills to support process improvements across departments.