Senior Credentialing & Compliance Analyst (Facilities)

Healthfirst; New York (NY); Hybrid; USD 70,000 - 100,000; Full time

Job summary

Healthfirst Credentialing department credentials and re-credentials providers, facilities and vendors; prepares hard-copy directories and reviews network provider data for accuracy and ensures compliance with regulatory requirements and federal and state regulations. Credentials providers, facilities, and vendors in accordance with regulations and Healthfirst policy.

Prepares presentations for the quarterly credentialing and delegate vendor oversight committee meetings.

Qualifications

• Minimum Qualifications: HS diploma/GED.
• Preferred Qualifications: Bachelor’s degree.
• Prior relevant experience in credentialing or related field is desirable.
• Strong time and project management, communication, and problem-solving skills.

Responsibilities

• Credential and re-credential providers, facilities, and vendors in accordance with regulations and Healthfirst policy.
• Prepare hard-copy directories and assist with posting online directories via third-party vendors.
• Review provider data for accuracy and regulatory compliance at both state and federal levels.
• Support quarterly credentialing and delegate vendor oversight committee materials and audits.
• Identify process improvement opportunities and assist management in resolution of issues.

Skills

Time management

Project management

Critical thinking

Communication

Problem solving

Microsoft Office

Education

HS diploma/GED

Bachelor’s degree (Preferred)

Tools

Adobe

Access

Excel

Word

PowerPoint

Office

Job description

Healthfirst Credentialing department credentials and re-credentials providers, facilities and vendors; prepares hard-copy directories and reviews network provider data for accuracy and ensures compliance with regulatory requirements and federal and state regulations. Credentials providers, facilities, and vendors in accordance with regulations and Healthfirst policy.

Prepares presentations for the quarterly credentialing and delegate vendor oversight committee meetings.