Credentialing Analyst - Full time

SolutionHealth • Nashua, NH

6d • Onsite

About The Position

The credentialing analyst position assists the manager in overseeing the credentials and enrollments for over 340 providers in Foundation Medical Partners and also assists the credentialing analyst at Southern NH Medical Center in onboarding new providers. This person also oversees the onboarding of new providers who will be providing services to Foundation Medical Partners. This position is vital to new providers starting on their anticipated start date to meet the clinical needs of the practice they are hired into. This allows the practice to maintain (if we are replacing a provider) or grow their patient access (if we are hiring an additional provider). The other vital component of this position is to get the provider enrolled with the payers our organization contracts with as soon as possible. This ensures our organization will be paid for the services they provide to our patients. With the robust activity of recruitment and the challenges of payer enrollments this position is essential in meeting our organization's goal of growing primary care, cardiovascular services, cancer care, digestive health, orthopedics, neurosciences and emergency/urgent care while also growing our financial strength.

Requirements

• At least two (2) years of healthcare office experience specifically within a credentialing role
• High School diploma or equivalent
• Proficient with Microsoft Office Suite, particularly Word, Excel, and Outlook
• Ability to maintain complex databases
• Exceptional time-management skills
• Keen eye for detail
• Ability to multitask effectively under tight deadlines
• Demonstrated ability to properly handle and protect highly confidential, sensitive information

Nice To Haves

• Experience in a medical staff services department is preferred
• Certified Provider Credentialing Specialist (CPCS) designation is a strong plus

Responsibilities

• Initiates the Medical/Allied Health Professional Staff appointment application process
• Outlines licensing and DEA requirements for NH and MA
• Verifies education contact information
• Initiates/Updates Professional Liability Insurance
• Prepares insurance applications for provider to complete and sign
• Completes/updates provider credentialing data in the universal Provider Data Source CAQH
• Initiates/maintains enrollment with insurance plans
• Follows up with insurance plan of provider effective date
• Updates insurance plans with provider/practice change of information
• Assists the Business Office with resolving claim processing issues due to provider enrollment
• Data entry in the credentialing software system of all provider license, DEA and Board Certification expirations
• Runs reports to notify provider and manager of expiring credentials
• Follows up on all expiring credentials to ensure compliance with provider employment agreement
• Researches Federal, State and Local guidelines for licensing and maintaining credentials

Benefits

• Health, dental, prescription, and vision coverage for full-time & part-time employees
• Short-term, long-term disability, life & pet insurance
• Tuition reimbursement & Nursing Student Loan Paydown Program
• 403(b) Retirement savings plans
• Continuous earned time accrual

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED