Credentialing Coordinator

Credentialing Compliance Analyst Position overview and responsibilities are focused on supporting the provider enrollment credentialing process to enable accurate billing and revenue generation. The role ensures compliance with regulatory standards set by The Joint Commission, Department of Health, NCQA, and other applicable requirements, and supports continuous improvement in credentialing operations. Job Description POSITION SUMMARY In this role, you will provide key support and analysis to the provider enrollment credentialing process, directly impacting AtlantiCare’s ability to bill for services rendered by billable providers. The framework for provider enrollment credentialing includes compliance with regulatory standards defined by The Joint Commission, Department of Health, NCQA, and Centers for Medicare and Medicaid Services. The Compliance Analyst will audit 100% of credentialing and reappointment (re-credentialing) files submitted by Credentialing Specialists to ensure compliance with NCQA, TJC accreditation and other regulatory standards, internal policies and procedures, and managed care plan requirements. The Analyst will audit data entered in the Credentialing database for completeness, accuracy, consistency, gaps, etc., follow up on audit errors to ensure corrections are made, and serve as a subject matter expert and coach for Credentialing Specialists. This position supports organizational goals by providing quality customer service, participating in performance improvement efforts, and demonstrating a commitment to teamwork and cooperation. QUALIFICATIONS EDUCATION: Bachelor’s degree preferred. LICENSE/CERTIFICATION: Not specified beyond general requirements. EXPERIENCE: 5 years in healthcare or managed care environment and/or related experience. Proficiency with spreadsheets, databases, and audit software. Analytical skills to define problems, collect data, establish facts, and draw valid conclusions. Strong written and verbal communication. Knowledge of audit theory, standards, procedures, and techniques. Ability to interpret and apply department policies and procedures. PERFORMANCE EXPECTATIONS Demonstrates the technical competencies as established on the Assessment and Evaluation Tool. WORK ENVIRONMENT This position requires desk/computer work, some standing and walking, and occasional lifting up to 20 pounds as needed. The essential functions for this position are listed on the Assessment and Evaluation Tool. Essential functions of this position are listed on the Assessment and Evaluation Tool. REPORTING RELATIONSHIP This position reports to Department Leadership. Note: The above statement reflects the general details considered necessary to describe the principal functions of the job and should not be considered a detailed description of all work requirements inherent in the position. Total Rewards at AtlantiCare At AtlantiCare, we believe in supporting the whole person. Our market-competitive Total Rewards package promotes physical, emotional, social, and financial well-being, including a comprehensive suite of benefits and resources: Generous Paid Time Off (PTO) Medical, Prescription Drug, Dental & Vision Insurance Retirement Plans with employer contributions Short-Term & Long-Term Disability Coverage Life & Accidental Death & Dismemberment Insurance Tuition Reimbursement to support educational goals Flexible Spending Accounts (FSAs) for healthcare and dependent care Wellness Programs to help you thrive Voluntary Benefits , including Pet Insurance and more Benefits offerings may vary based on position and are subject to eligibility requirements. Join a team that values well-being and invests in your future. Job Information Job Identification : 100303 Job Category : Human Resources Job Schedule : Full time Job Shift : Day Pay Range : $29-$43.65 per hour Holidays Required : No Weekends Required : No Hrs Per Week : 37.5 EEO Statement: AtlantiCare is an Equal Opportunity Employer, including veterans and individuals with disabilities. #J-18808-Ljbffr