Analyst, Credentialing & Delegation

Concentra•Addison, TX

About The Position

Concentra is recognized as the nation’s leading occupational health care company. With more than 40 years of experience, Concentra is dedicated to our mission to improve the health of America’s workforce, one patient at a time. With a wide range of services and proactive approaches to care, Concentra colleagues provide exceptional service to employers and exceptional care to their employees. Primary responsibilities include partnering with the National Clinician Credentialing and Delegation Business Leader in assuring Concentra’s Credentialing Plan and processes meets the needs of our clients, payers, the market, state regulations and NCQA, Medicare/Medicaid, URAC, and/or Joint Commission credentialing standards. This includes, but is not limited to, creating and/or assisting with the development and/or implementation of supporting policies and procedures and workflows; managing and monitoring the overall Credentialing Plan, the on-going evaluation of the effectiveness of processes and procedures to support the plan; ensuring Concentra is in compliance with state regulatory, NCQA, URAC, Medicare/Medicaid, and/or Joint Commission credentialing requirements, as applicable; legislative credentialing laws; and accrediting body requirements. The Analyst works independently but reports to the National Clinician Credentialing and Delegation Business Leader and coordinates and collaborates with Concentra business leaders and colleagues on day-to-day operations and serves as the secondary subject matter expert for credentialing processes.

Requirements

Education Level: Bachelor’s Degree Major: Degree must be from an accredited college or university.
Certifications and/or Licenses:
Professional Medical Services Management Certification (CPMSM) and/or Professional Credentialing Specialist Certification (CPCS) preferred. If not certified, at least one certification is to be obtained within 15 months of hire.
Continuing Education Units (CEUs) to maintain certifications
Minimum of five years credentialing experience with three years of credentialing oversight experience
Direct credentialing oversight experience required
Knowledge of credentialing software (IntelliCred) preferred
Working knowledge of NCQA and URAC Credentialing Standards
Concentra Core Competencies of Service Mentality, Attention to Detail, Sense of Urgency, Initiative and Flexibility
Ability to make decisions or solve problems by using logic to identify key facts, explore alternatives, and propose quality solutions
Outstanding customer service skills as well as the ability to deal with people in a manner which shows tact and professionalism
The ability to properly handle sensitive and confidential information (including HIPAA and PHI) in accordance with federal and state laws and company policies
Manage open projects to the end with successful follow-up
Knowledge of credentialing processes and procedures and systems
Experience with computer software applications to include Word, Excel, Power Point, Outlook and ability to utilize proprietary Concentra software programs
Working knowledge of credentialing organizations such as NCQA and URAC
Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, government regulations, standardized instructions, short correspondence, and memos
Demonstrated excellent communication skills, both written and oral, with varying levels of colleagues, management, clients and customers
Capable of speaking effectively before groups of customers or employees of organization
Effectively present information in one-on-one situations to other employees, providers and clients
Must have a demonstrated understanding of credentialing as defined by legislative/regulatory or state bodies
Proven ability to work in fast paced environment
Required to be very detail-oriented
Must be able to make independent decisions
Review and make necessary revisions in credentialing delegation agreements with external payer partners

Nice To Haves

Professional Medical Services Management Certification (CPMSM) and/or Professional Credentialing Specialist Certification (CPCS) preferred.
Knowledge of credentialing software (IntelliCred) preferred

Responsibilities

Implement and coordinate strategic goals to align with department and corporate goals and objectives
Monitor the overall credentialing plan, operations and needs for compliance, working with the National Business Leader to make any necessary changes.
Maintain all Credentialing activities for Concentra centers, onsites/worksites, Medical Review Stream by Concentra, and any other credentialing needs that arise
Partner with the National Business Leader on the credentialing and recredentialing of Concentra facilities/centers.
Partner with multi-functional team of business leaders on day-to-day Concentra operations
Maintain knowledge of all state regulatory and accrediting body standards and maintain compliance
Maintain knowledge of market driven and client requirements to ensure Concentra is meeting these requirements
Working with the Senior Director of Credentialing and Enrollment and National Business Leader, develop, implement and coordinate the on-going activities of all Committees (i.e., Credentialing and Appeal Committees)
Proficiently review and manage payer Delegated Agreements, working directly with the National Business Leader and payer partner to reach agreement on contract terms and deliverables. Work with the Senior Director of Credentialing and Enrollment and National Business Leader on all audit and reporting needs associated with each agreement.
Participate in client, state and/or regulatory body interviews/presentations in discussions pertaining to credentialing
Oversee and manage ongoing monitoring activities such as OIG Sweep (Office of Inspector General) for Medicare/Medicaid sanctions, Medicare Opt Out, CMS Preclusion, and monthly state licensure sanctions/actions
Support the National Business Leader in the management of the credentialing committee process and meetings to assure committee members have necessary information, explain questionable information contained in file and act as overall resource for general credentialing processes
Partner with the National Business Leader in assisting the Senior Director of Credentialing and Enrollment with development of mechanisms for regular on-going feedback on areas of development and/or accomplishments
Work with National Business Leader to conduct monthly random file audits of credentialing/recredentialing files and reporting findings back to Senior Director of Credentialing and Enrollment for correction/POA of processes and procedures
Partner with the National Business Leader to actively seek additional delegation opportunities with external payer partners to increase department efficiencies