Analyst, Physician Credentialing (Payor Enrollment)

ArchWell Health • Nashville, TN

2d • Remote

About The Position

ArchWell Health is a healthcare provider focused on improving the lives of senior members through accessible neighborhood clinics and wellness-focused communities. 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 applications to managed care plans and government payors, provider data maintenance, and tracking license and certification expirations. The analyst also serves as a liaison among payors, external credentialing service firms, and medical staff, including physicians.

The position develops credentialing workplans and processes for providers and facilities, completes enrollment workflows, monitors application submissions, manages payor reporting and monthly exclusion checks, and oversees renewals. It also supports new payor operations as contracts are executed and takes on other assigned projects and tasks. The position is remote.

Requirements

• At least three years of medical credentialing and enrollment experience.
• Understand Medicare, Medicaid, and managed care plan credentialing requirements.
• Be familiar with CAQH and communicate professionally with providers to assist with CAQH applications.
• Knowledge of medical terminology.
• Strong organizational 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 staff at all levels and internal and external stakeholders.
• Detail oriented.
• Proficient PC skills.
• Embody and serve as a role model for ArchWell Health’s values: compassion, striving for excellence, earning trust, showing respect, resilience, and always doing the right thing.

Nice To Haves

• Bachelor’s degree preferred.

Responsibilities

• Build ArchWell Health credentialing workplans and processes, including credentialing requirements for providers and facilities imposed by government payors and contracted managed care plans.
• Complete credentialing and enrollment workflows for providers and facilities, including data collection and primary source verification.
• Monitor and maintain the end-to-end application submission process for assigned payor contracts to ensure providers are credentialed in a timely manner.
• Own payor reporting, including data reporting and monthly exclusion checks.
• Oversee ongoing renewals for required provider licenses and credentials.
• Assist in building new payor operations as new contracts are executed.
• Act as a liaison among government payors, managed care plans, outsourced credentialing services, and ArchWell Health medical staff, including providers.
• Maintain provider data and files and track certification and license expirations.
• Complete other projects and tasks as assigned.

What This Job Offers

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