Date Posted:

03/12/2025 Hiring Organization:

Rose International Position Number:

479526 Job Title:

Credentialing Analyst Job Location:

Cumberland, RI, USA, 02864 Work Model:

Hybrid Shift:

M-F 8am-4:30pm ET (hybrid schedule - will be required to be in office and can also work from home) Employment Type:

Temporary Estimated Duration (In months):

6 Min Hourly Rate ($):

22.00 Max Hourly Rate ($):

25.00 Must Have Skills/Attributes:

Credential Verification, Data Analysis, Healthcare, MS Excel, Multitask

Job Description

Required Education: • Associate degree

Required Qualifications/Skills/Experience: • Demonstrated understanding of initial credentialing and re-credentialing practices for medical professionals including primary source verification methods, compliance monitoring and expirable management. • Proficient in quantitative analysis • Understanding of Joint Commission Accreditation, NCQA and URAC credentialing standards. • Ability to function independently and utilize critical thinking skills to accomplish goals and objectives • Effective communication skills; verbal and written • Strong interpersonal skills including the ability to work well with internal and external stakeholders • Strong organizational skills and the ability to multitask • Competent user of Microsoft Office, Outlook, MDStaff, Word, and Excel • A minimum of 3 years’ experience in the healthcare industry with experience in credentialing

Preferred Qualifications/Skills/Experience: • NAMSS Certified Professional Credentialing Specialist (CPCS) certification

The coordinator III will work directly with other coordinators to ensure quality of work delivered, performance/productivity benchmarks are met, and all compliance-related issues are properly addressed, trained and coached on a consistent basis. The Enrollment Coordinators play a critical role in working with our new member clients to determine eligibility and perform various enrollment activities. Enrollment Coordinators interface with both individual plan members and employer group and requires a strong focus around accurate and timely customer support to ensure client enrollment and retention. The Enrollment Coordinator III reports directly to the Enrollment Supervisor, also functioning as SME (Subject Matter Expert) in the functions, processes, and eligibility procedures as they relate to Medicare Part D enrollment and CMS (Center for Medicare/Medicaid Services) Standards.

Job Duties: • Data analysis and/or the initialing credentialing and re-credentialing of nurse practitioners, physician assistants, Behavioral Health Providers and physicians in a compliant and timely manner; monitor expired credentials and compliance monitoring in accordance with Joint Commission accreditation, NCQA and URAC credentialing standards as required. • Responsible for the timely and accurate processing of all providers including NP’s/PA’s/MD’s Re-credentialing applications according to the Minute Clinic Provider Credentialing Program • Monitor Expired licensure reporting, data base tasks and maintain system updates and weekly reporting to leadership • Manage Epic access for any providers that have out of compliance licensure and/or board certification. Analyst will work directly with other coordinators to ensure quality of work delivered, performance/productivity benchmarks are met, and all compliance-related issues are properly addressed, trained and coached on a consistent basis. • Conduct sanctions and compliance monitoring and alert Data Analyst Manager and Credentialing Manager of any undisclosed negative findings • Process malpractice insurance verification requests according to internal policies when applicable • Maintain the provider and physician SharePoint sites and Communicate provider statuses with leadership and other internal teams to meet timelines • Submit system access requests upon credentialing approvals/clinic eligibility • Support the payer enrollment team as needed to resolve any payer claim issues • Monitor Provider and Clinic change/Termination reports and update database accordingly • Process Name changes according to Minute Clinic policies and procedures • Daily maintenance of provider credentialing grids with notification to appropriate teams • Review and distribute all incoming mail as needed • Support Payer Audits in accordance with Minute Clinic, Joint Commission and NCQA requirements • Maintain provider files with the most current information/documentation • Notify system analyst and leadership of any system and state agencies interruptions/updates/password changes • Make recommendations for process improvement and system efficiencies • Attend and engage in all team meetings

**Only those lawfully authorized to work in the designated country associated with the position will be considered. **

**Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements. **

Benefits: For information and details on employment benefits offered with this position, please visit here. Should you have any questions/concerns, please contact our HR Department via our secure website.

California Pay Equity: For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations' website here.