Credentialing Analyst

Options for Southern Oregon • Grants Pass, OR

5d • Hybrid

About The Position

The Credentialing Analyst manages credentialing for agency employees, subcontractors, contracted facilities, and other providers as assigned. The role ensures that providers meet and maintain required qualifications, certifications, and regulatory standards, and that credentialing and primary source verification comply with organizational policies and accrediting agency, federal, and state requirements. The position works with Coordinated Care Organizations (CCOs), Community Partners, and state and federal agencies to ensure credentialing processes and policies meet standards and compliance requirements.

The analyst works independently under general supervision, adjusts to changing priorities, organizes workload to meet organizational needs and deadlines, and maintains strict confidentiality. The schedule is generally Monday through Friday, 8 a.m. to 5 p.m., with some flexibility and a hybrid work schedule available.

Requirements

• Experience in healthcare provider credentialing.
• Education and experience sufficient to provide the skills and abilities needed to perform the essential functions of the position.
• Flexibility to address changing priorities and projects in a fast-paced environment.
• Strong attention to detail and outstanding organizational skills.
• Must pass state-required background and DMV checks.
• Valid Oregon driver's license and satisfactory driving record.
• Ability to work independently and flexibly under general supervision.
• Understanding of HIPAA requirements regarding confidentiality of privileged information.
• Ability to follow verbal and written instructions.

Nice To Haves

• Behavioral health credentialing experience.

Responsibilities

• Develop and maintain provider enrollment materials and processes, and assist providers with applications and credentialing paperwork.
• Initiate and track provider enrollment with insurance companies and follow up on provider participation status.
• Process Medicare and Medicaid provider enrollment and third-party credentialing.
• Monitor credentialing and licensing statuses for licensed clinical providers, track re-credentialing requirements, create workflows as needed, and ensure licenses remain active and in good standing.
• Coordinate with staff and outside agencies to obtain information needed for credentialing.
• Assist licensed and certified staff with registration and certification applications and processes; track progress and communicate with state agencies.
• Manage credentialing and re-credentialing for agency staff, subcontractors, and contracted facilities, including healthcare professionals such as Nurse Practitioners, Licensed Mental Health Clinicians, and Psychiatrists.
• Oversee hospital credentialing of Crisis Specialists and liaise with outside agencies to complete the process.
• Develop and carry out communications that keep supervisors, managers, the COO, and Medical Billing staff updated on credentialing, background checks, registry status, and other matters affecting agency performance and compliance.
• Work with the Medical Billing Department and CCOs to ensure credentialing data is accurate for billing and reporting, research issues, and make adjustments as necessary.
• Perform National Provider Data Bank queries, primary source verification of licensure and education, and other compliance screening.
• Prepare for and participate in credentialing audits conducted by outside agencies.
• Handle sensitive and confidential information in accordance with organizational confidentiality policies.

Benefits

• Family medical insurance
• Dental insurance
• Long-term disability
• 403(b) plan with 6% match
• Paid time off, with annual accrual up to 208 hours based on FTE status and available to use upon accrual
• 11 paid holidays annually

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed