Credential Analyst-NCQA, URAC and CMS

Health Care Service Corporation•Southfield, MI

2d•Hybrid

About The Position

Under supervision, this role is responsible for performing oversight on essential credentialing functions to attain and maintain quality providers in the dental network. This role also conducts audits for credentialing as well as network data quality. Understands credentialing policies and procedures per NCQA, URAC and CMS standards and other regulatory requirements. Serves as a liaison to delegated entities and vendors to ensure current and adequate credentialing process are in place. Develops and performs queries for data reporting purposes to include directories, ad hoc reports, and network management reports. Responsible for the monitoring and maintenance of credentialing and re-credentialing polies and program as well as state and federal requirements to ensure compliance is met. This role will provide operational and industry knowledge to ensure credentialing practices.

Requirements

Bachelor degree and 2 years of experience in accreditation programs (i.e., NCQA, URAC and CMS programs) or 6 years of experience in accreditation programs
Proficiency in accreditation program standards. (ex. NCQA, URAC, CMS)
Knowledge of state and federal requirements for contracting and credentialing.
Attention to detail and ability to track information to defined quality standards
Knowledge of documents and their contents used in provider contracting, including applications, agreements, fee schedules, and credentialing.
Knowledge of provider contracting terms.
Analytical skills
Demonstrated experience understanding and maintaining detailed complex provider records.
Attention to detail and ability to enter data and meet defined quality standards
Experience balancing multiple priorities while meeting commitments for quality and delivery at agreed upon schedules.
Clear and concise verbal and written communication skills.
Proficient in Microsoft Office products, Excel, email and Internet.
Ability to work well in a team environment.

Nice To Haves

Analytical skills
Knowledge of Dental industry

Responsibilities

Performing oversight on essential credentialing functions to attain and maintain quality providers in the dental network.
Conducting audits for credentialing as well as network data quality.
Serving as a liaison to delegated entities and vendors to ensure current and adequate credentialing process are in place.
Developing and performing queries for data reporting purposes to include directories, ad hoc reports, and network management reports.
Monitoring and maintenance of credentialing and re-credentialing policies and program as well as state and federal requirements to ensure compliance is met.
Providing operational and industry knowledge to ensure credentialing practices.