Credentialing Analyst

Job Description

Roles & Responsibilities • Reviews practitioner registration forms and applications for completeness and collects data within defined timeframes. • Reviews and documents findings of practitioner performance and credentials. • Supports client onboarding and set up of provider profile. • Helps training staff on Credentialing and Contracting processes. • Prepares summaries for missing information request, notes for tasks and peer review. • Prepares final committee-ready credentialing provider files for delegated clients. • Adheres to strict confidentiality guidelines and Code of Conduct standards; conforms to defined processes in compliance with quality standards and regulatory requirement. • Creates and enters practitioner data into profile, CAQH, provider portal, applications and group applications in credentialing software and obtains missing information and/or documents required, as needed. • Sends expired license, insurance, etc. notifications to providers. • Updates provider records with current license, insurance, COI, DEA, etc. • Mails re-credentialing applications to providers, Health plans and logs receipt of