Analyst, Physician Credentialing (Payor Enrollment)

ArchWell Health • Nashville, TN

7d • Remote

About The Position

ArchWell Health is a healthcare provider focused on improving the lives of senior members through neighborhood clinics and wellness-focused care. Reporting to the Director of Provider Credentialing, the Provider Credentialing Analyst credentials new providers and maintains current provider files for a growing medical group. The role partners with credentialing staff and owns the end-to-end credentialing process, including submitting and tracking applications to contracted managed care plans and government payors, maintaining provider data, tracking certification and license expirations, and serving as a liaison among payors, external credentialing services, and medical staff.

Requirements

• Understand Medicare, Medicaid, and managed care plan credentialing requirements.
• Be familiar with CAQH (Council for Affordable Quality Healthcare).
• At least three years of medical credentialing and enrollment experience.
• Knowledge of medical terminology.
• Strong organization skills and written communication skills.
• Ability to work independently and conduct research while performing job duties.
• Tech savvy and willing to learn CredentialStream.
• Excellent communication skills to work effectively with internal and external stakeholders at all levels.
• Detail oriented.
• Proficient PC skills.
• Embody ArchWell Health’s values: compassion, striving for excellence, earning trust, showing respect, resilience, and doing the right thing.

Nice To Haves

• Bachelor’s degree preferred.

Responsibilities

• Build credentialing workplans and processes for providers and facilities in accordance with government payor and contracted managed care plan requirements.
• Complete provider and facility credentialing and enrollment workflows, including data collection and primary source verification.
• Monitor and maintain the end-to-end application submission process for assigned payor contracts to ensure timely provider credentialing.
• Own payor reporting, including data reporting and monthly exclusion checks.
• Oversee renewals of required provider licenses and credentials.
• Help build new payor operations as new contracts are executed.
• Serve as a liaison among government payors, managed care plans, outsourced credentialing services, and ArchWell Health medical staff, including providers.
• Assist providers professionally with completing CAQH applications.
• Complete other projects and tasks as assigned.

What This Job Offers

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