Contract Credentialing Analyst - Ambulatory Infusion Clinics (AIC)

Option Care Health•Bannockburn, IL

1d•$57,188 - $95,313

About The Position

The Analyst, Contract Credentialing is responsible for managing the payer credentialing lifecycle, from initial receipt through submission, for existing and new pharmacies. The analyst independently completes complex credentialing requests, forms, attestations, and credentialing audits. The position completes initial credentialing and re-credentialing applications and supports payer and internal teams in resolving potential non-compliance. It maintains credentialing tracking and renewal processes, applies internal databases and policies to applications, and identifies issues requiring review by Legal, Litigation, Risk, Compliance, Clinical, Operations, or Contracting. The analyst maintains knowledge of applicable credentialing requirements and state and federal regulations. The analyst also prepares monthly demographic reports, manages credentialing inquiries through a shared department email box, reviews patient-specific letters of agreement, and facilitates signatures for payer agreements and selected letters of agreement. The role maintains working relationships with internal departments and assists with ad hoc projects and initiatives. The position has no supervisory responsibilities.

Requirements

Bachelor’s degree and at least 2 years of experience in payer credentialing or provider enrollment, or a high school diploma/GED and at least 5 years of experience in payer credentialing.
Experience completing provider credentialing applications or provider enrollment in the medical field.
Experience prioritizing, organizing, tracking details, and meeting deadlines across multiple projects with varying completion dates.
Experience building and maintaining excellent internal and external working relationships.
Intermediate Microsoft Word skills, including creating and modifying text styles, numbering and sorting lists, working with sections and columns, formatting tables, using templates, and using diagrams and drawing tools.
Intermediate Microsoft Excel skills, including formatting cell text and borders, working with workbooks and worksheets, using range names and cell references, sorting, and auto filtering.
Detail orientation and ability to manage multiple priorities, meet deadlines, and adjust to changing priorities.

Nice To Haves

Bachelor’s degree and at least two years of home infusion and/or specialty pharmacy credentialing experience.

Responsibilities

Complete initial credentialing and re-credentialing applications, provider information forms, enrollment forms, disclosures, and attestations for providers seeking participation in commercial medical and pharmacy networks; ensure submitted provider information is accurate.
Communicate with third-party payers and internal teams to resolve potential non-compliance.
Maintain the internal tracking system for credentialing requests, submissions, and renewals, and proactively submit renewals.
Use internal databases, licensing, accreditation, and internal policies to complete applications; identify questions requiring review by Legal, Litigation, Risk, Compliance, Clinical, Operations, or Contracting.
Maintain knowledge of state and federal credentialing regulations and contracted plans, networks, and credentialing requirements.
Generate monthly demographic reports for internal customers in a standardized spreadsheet format, identifying recent and upcoming changes.
Complete monthly demographic reports in third-party payer formats, including relevant enrollment, provider type, monthly change, and service area information; review reports with payers to ensure required data is accurate.
Co-manage the department email box, assess credentialing or payer needs, respond to inquiries promptly, resolve basic contract questions, and escalate matters as needed.
Review incoming patient-specific letters of agreement for completion and submission for approval.
Facilitate signatures for third-party payer agreements and selected patient-specific letters of agreement through internal or client e-signature platforms or original-signature processes.
Review documents and potential revenue impact to determine the appropriate internal signer in accordance with company policy.
Complete credentialing or demographic information required in contractual documents.
Maintain working relationships with Operations, Legal, Sales, and other departments involved with or impacted by third-party payer contracts.
Assist with ad hoc projects, requests, and initiatives assigned by management.