Senior Analyst, Credentialing Operations

Oscar Health•Atlanta, GA

6h•Remote

About The Position

You will work to support and enhance the quality of the credentialing functions. Positively impact provider experiences and member outcomes by ensuring provider data is maintained consistently and managing critical/complex data escalations to resolution. Communicate with providers and work collaboratively with other teams to provide efficient and thorough resolution by providing world class service. You will report into the Manager, Provider Credentialing. Work Location: This is a remote position, open to candidates who reside in: Georgia . While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.

Requirements

2+ years of credentialing experience, both individual practitioner and facility, adhering to NCQA standards
2+ years of intermediate Excel/Google Sheet proficiency
2+ years of assessing and comprehending end to end process impact
2+ years experience resolving credentialing problems
2+ years of inventory management queue experience

Nice To Haves

2+ years of intermediate proficiency in SQL, BigQuery or similar database language experience
Background in health insurance
Proficiency with non Microsoft business platforms
Proficiency in using a credentialing or provider data repository
Primary Source Verification Experience with healthcare data such as provider data

Responsibilities

Maintain existing and incoming provider information to ensure accuracy and quality of the network by supporting complex non-standard provider information processing needs.
Assist with administrative process improvements to enhance productivity
Provide ongoing training and support to Credentialing Operations team members
Conduct Primary Source Verification (PSV) and validate practitioner and facility credentials in compliance with NCQA standards
Support employees on the team of all levels through escalation research and resolution
Effectively communicate findings and resolutions with providers and internal departments inclusive of collaboration with cross-functional stakeholders
Manage queue work and assigned caseload through effective dashboard management while ensuring integrity of information entered into company and external systems.
Support junior employees in queue management and prioritization.
Compliance with all applicable laws and regulations
Other duties as assigned