Provider and Credentialing Network Analyst

  • Location
    Columbia, Maryland
  • Job type
    Contract/Temporary
  • Category
    Call Center & Customer Service - Customer Service

A large healthcare company in the Mid Atlantic has an immediate need for Provider and Credentialing Network Analysts!

PURPOSE:

The associate analyzes and researches applications and correspondence from professional providers and ancillary providers for participation or non-participation in the company's networks for GHMSI and CFMI. This position is responsible for the technical maintenance, initial entry and update of data on the Provider Database Files and the data that feed to the NASCO, FACETS, FEP and the Operational Data Store (ODS). Maintains and updates all aspects of the corporate databases for network providers, including credentials, addresses, contracting status, etc. so that the data can be used throughout the company's organization. Process all termination and cancellation requests from professional providers. Service external and internal inquiries regarding provider status and credentialing criteria.

PRINICIPAL ACCOUNTABILITIES:

35% Analyzes and researches credentialing applications/provider contracts to verify that appropriate information has been obtained as well as handles incoming and outgoing correspondence regarding the applications. Determines the appropriate networks for participation and obtains the appropriate executed contracts. Maintains the on-line provider file and hardcopy file with updated provider information- Credentials and re-credentials providers to appropriate levels. Maintains the Application Log in accordance with state legislation.


30% Assign provider numbers and updates demographic information on the corporate database for publishing provider information in our various directories. Processes applications and updates in accordance with applicable state laws and guidelines. Maintains database for all provider information updates to support corporate mainframe system for all network provider or subscriber inquiries and is fundamental in supporting the provider special pricing process.

20% The incumbent addresses questions involving professional entities and
Contractual questions. Determines the nature of inquiry, researches available information and determines the proper actions required. Responds to external and internal inquiries regarding provider participation eligibility and criteria, participation status and provider file updates.

10% Prepares written responses in order to obtain incomplete or missing information. Mails appropriate provider packet when required. Mails confirmation letter to professional providers identifying necessary provider numbers for proper billing.


5% Verification and release of all data entered into the database. Complete updates to the departments inventory control system (IACS) documenting cases completed or case in a pend status.


QUALIFICATION REQUIREMENTS:

Credentialing or Provider file maintenance experience
Analytical Skills to research and analyze data
High school diploma with 2 years of college or commensurate work experience.
3-5 years direct experience with provider contracting, credentialing or network management.
Knowledge of medical terminology
Strong service skills and possess ability to remain calm in stressful situations with medical professionals.
Experience working on a diverse team and collaborating on common issues
Demonstrated success in handling large volumes of work


ABILITIES/SKILLS:

Effective verbal and written communication skills
Ability to work as a member of a team
Familiarity with PC and mainframe applications
Ability to organize, prioritize, and accomplish tasks within established timeframes
Ability to prioritize multiple tasks and remain focused
Demonstrated proficiency utilizing reference materials.

PHYSICAL DEMANDS:

The physical demands described here a representative of those that must be met by an associate to perform the essential duties and responsibilities of the position successfully. Requirements may be modified to accommodate individuals with disabilities.

The associated is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The employee must frequently talk and hear. Weights of up to 25 pounds are occasionally lifted.

Equal Opportunity Employer
Minorities/Women/Veterans/Disabled

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Reference number US_EN_1_027071_11934862