Credentialing Compliance Analyst Jobs (NOW HIRING)

Onsite in The Bronx @ our client's central HR office Monday - Friday, 9am - 5pm EST (some flexibility)

Under the supervision of the Credentialing Manager, the Credentialing Coordinator will organize and maintain all aspects of the credentialing process and functions related to the Credentialing Department. The responsibilities of this position, include but are not limited to, tasks that are related to the initial credentialing and recredentialing of Other Licensed Certified Practitioners (OLCP) and Other Clinical Staff (OCS). The Coordinator will arrange document collection, verifications, and file maintenance for his/her category of providers. The Coordinator is responsible for analyzing and evaluating credentials and maintaining files in accordance with organizational policy, accreditation requirements and regulatory standards. The Coordinator ensures the appropriateness and accuracy of each document in credentialing files, databases and spreadsheets.

Key Essential Functions:

1. Maintain communication with Human Resources (HR), practitioners and program leaders to coordinate the receipt of information required for credentialing, credentialing, status changes, terminations and expiring credentials for OLCP and Other Clinical Staff.
2. Perform thorough review and analysis of provider applications, accompanying documents and files for new and existing providers.
3. Identify discrepancies and resolve them quickly, ensuring credentialing compliance, including but not limited to, missing, incomplete, or differing information on documents (i.e., resume, certifications/registrations, application).
4. Continuously evaluate file elements to determine if additional information is needed and follow up as appropriate to resolve.
5. Identify issues that require additional investigation and evaluation such as validating discrepancies, adverse reports, negative reviews or ratings, and undisclosed matters that arise through the process. Ensure that those issues are brought up for review and discussion with the Credentialing Manager immediately.
6. Perform relevant primary source verifications including, but not limited to, licensure, registrations, certifications, affiliations, malpractice, National Practitioner Data Bank (NPDB), Office of Inspector General (OIG), Office of Medicaid Inspector General (OMIG) and other agencies as delineated by credentialing process.
7. Perform timely data entry and upkeep of provider information in the credentialing database, related spreadsheets and credentialing file.
8. Monitor OLCP and clinical staff training per regulatory agency (tracking, notifications, pursuit and storage).
9. Perform internal audits of credentialing files and resolves non-compliance components by pursuing missing elements and correcting erroneous documents.
10. Assist in all external audits, i.e., Human Resource Services Administration (HRSA), Office of Alcohol and Substance Abuse Services (OASAS), The Joint Commission (TJC), Office of Mental Hygiene (OMH) and Department of Health (DOH) and managed care companies. This will include preparing and scanning files; updating audit rosters and obtaining missing items from providers and program directors.
11. Work collaboratively with Human Resources and department leaders on day-to-day credentialing and privileging issues as they arise.
12. Participate in all regulatory, accreditation and managed care audits involving credentialed providers.
13. Provide timely responses to data requests.
14. Coordinate and collaborate with peers towards systematic efforts to maintain data integrity.
15. Recommend and initiate ideas for process improvement.
16. All other duties as assigned by Credentialing Manager or designee, as it pertains to credentialing.

Core Responsibilities:

• Credentialing and privileging: Process initial applications and re-credentialing for physicians and allied health professionals to ensure they meet requirements for providing patient care.
• Data management: Maintain accurate and up-to-date electronic and hard-copy files for all providers, including licenses, certifications, and malpractice insurance. This includes managing CAQH profiles to ensure they are current.
• Compliance: Ensure adherence to Joint Commission (JCAHO) standards, as well as state and federal regulations, by regularly verifying credentials and following established policies.
• Software and database management: Enter, update, and maintain provider information in the credentialing software system and use the software to track expirations and generate reports.
• Communication: Act as a liaison with healthcare providers, medical staff offices, and other internal and external departments, such as compliance, to resolve discrepancies and provide information.
• Audits and reporting: Assist in preparing for and participating in internal and external audits. Prepare reports on credentialing activities and submit necessary information to regulatory and accrediting bodies.
• Proactive renewal management: Monitor and track expiring licenses, certifications, and other credentials to ensure timely renewals and avoid service disruption.

Requirements:

Requirements (Qualifications, Skills and Competencies):

• High School Diploma/GED required. Associates degree preferred.
• Minimum of one (1) years of experience in a Human Resources or Credentialing Department capacity in a healthcare environment, with knowledge of onboarding functions, procedures and processes.
• Clinical Credentialing software experience (Cactus, CAQH, Symplr, Med Staff, etc.)
• Understanding of The Joint Commission standards (JCAHO)
• Proficient in Microsoft Office suite (i.e., Outlook, Excel, Word and Power Point).
• Must display efficiency in compliance management, document management, on/off boarding management, and privileging management, possessing the following knowledge, skills and attributes to fulfill credentialing goals:

1. Extreme attention to detail;
2. Agility to manage conflicting priorities;
3. Ability to deduce which priority is most important amongst competing deadlines;
4. Process mindset: approach problems, develop solutions, make suggestions for improvements;
5. Takes initiative and asks questions;
6. Capacity to organize and structure work load;
7. Capability to handle a large volume of emails on daily basis;
8. Ability to follow through and complete an activity or process that has been started.
9. Excellent verbal and written communication skills digitally or in person.