NEW JOB OPENING
CREDENTIALING ANALYST / COORDINATOR
IN Cumberland, RI, USA!

Required Education:

• Associate's or Bachelor’s degree



Preferred License/Certification:

• NAMSS Certified Professional Credentialing Specialist (CPCS) certification preferred



Required Qualifications/Skills/Experience:

• Minimum of 3 years of experience in the healthcare industry, including credentialing

• Demonstrated understanding of initial credentialing and re-credentialing practices for medical professionals

• Experience with primary source verification, compliance monitoring, and expirable management

• Proficiency in quantitative analysis

• Understanding of Joint Commission Accreditation, NCQA, and URAC credentialing standards

• Ability to work independently and use critical thinking to accomplish goals and objectives

• Effective verbal and written communication skills

• Strong interpersonal skills and ability to collaborate with internal and external stakeholders

• Strong organizational skills and ability to multitask

• Proficiency with Microsoft Office, Outlook, MDStaff, Word, and Excel



Credentialing Analyst / Coordinator Overview:

• The Credentialing Analyst / Coordinator is responsible for the timely and accurate initial credentialing and re-credentialing of nurse practitioners, physician assistants, behavioral health providers, and physicians

• The role includes monitoring expired credentials, maintaining compliance, and ensuring credentialing activities align with Joint Commission Accreditation, NCQA, and URAC standards

• Responsibilities include processing credentialing applications, verifying provider licenses and board certifications, monitoring sanctions and compliance findings, maintaining provider records and credentialing databases, and preparing reports for leadership

• The analyst also coordinates provider system access, communicates provider status to internal teams, supports payer enrollment activities and audits, and helps resolve credentialing and compliance issues

• This position works closely with other coordinators and stakeholders to maintain quality, accuracy, productivity, and compliance with established procedures

• The ideal candidate has strong quantitative analysis, organizational, communication, and critical-thinking skills, along with proficiency in MDStaff and Microsoft Office applications



Job Duties:

• Process initial and re-credentialing applications for nurse practitioners, physician assistants, physicians, and behavioral health providers in accordance with established provider credentialing procedures

• Monitor expired licensure reports, database tasks, and system updates

• Maintain systems and prepare weekly reports for leadership

• Manage Epic access for providers whose licenses or board certifications are out of compliance

• Collaborate with other coordinators to maintain work quality, meet performance and productivity benchmarks, and address compliance-related issues consistently

• Conduct sanctions and compliance monitoring and notify the appropriate credentialing and data analyst managers of undisclosed negative findings

• Process malpractice insurance verification requests according to internal policies

• Maintain provider and physician SharePoint sites

• Communicate provider statuses to leadership and internal teams to meet established timelines

• Submit system access requests following credentialing approval and clinic eligibility

• Support the payer enrollment team in resolving payer claim issues

• Monitor provider and clinic change and termination reports and update databases accordingly

• Process provider name changes according to established policies and procedures

• Maintain provider credentialing grids daily and notify appropriate teams of updates

• Review and distribute incoming mail as needed

• Support payer audits in accordance with applicable accreditation and credentialing requirements

• Maintain provider files with current information and documentation

• Notify system analysts and leadership of system interruptions, state agency updates, and password changes

• Recommend process improvements and system efficiencies

• Attend and actively participate in team meetings

• Maintain a positive and collaborative attitude when interacting with team members

• **Only those lawfully authorized to work in the designated country associated with the position will be considered.**

• **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.**