Mercy Health System of Maine
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Credentialing Data Analyst - Beacon Direct
at Mercy Health System of Maine
8:00 am - 4:30 pm
The Credentialing Data Analyst will be responsible for both performing credentialing and provider support activities as well as maintaining the integrity of the provider and practice data that will further support downstream processes, applications and reports. This position will design, maintain and produce both adhoc and ongoing reports. Extensive use of Microsoft Office Suite is critical. This position must have a keen eye for detail and communicate effectively within all levels. This position will support the credentialing processes by maintaining the various prompts that will monitor and maintain efficiencies. This position must be able to support multiple reporting initiatives both internal and external to adhere to credentialing regulatory deadlines as well ACO requirements.
Maintains all master practice data to support downstream process, reports and applications for credentialing and ACO activities
Performs duties for credentialing, re-credentialing, changes and terminations of providers in compliance with State law, NCQA guidelines and department procedures to ensure timely provider credentialing.
Investigate and resolve questions and inquiries regarding payor status, and other network functions.
Collaborates in the development of credentialing and other educational materials and programs for the department.
Manages questions regarding provider credentialing. Sends credentialing materials and maintain all applicable files.
Extracts, reports, and analyzes data generated primarily from our credentialing software
Maintain website provider directories
Maintain all expiring documentation by tracking and obtaining all applicable documentation and ensuring primary source verification is completed in a timely basis according to regulations and policies.
Establishes and maintains all written and electronic procedures
Maintain ongoing education for all staff to include cross-training opportunities across the team
Maintains standardized data field dictionary
Designs, Manages and Runs adhoc and standard reports to meet the needs of various departments
Assists Manager with monitoring of individual and department metric reviews
Ensures data entered into systems are accurate and complete
Establishes close working relationships within internal and external departments
Performs as a solid team player and works closely with staff, specifically the Director and Credentialing Manager
Processes and distributes appropriate correspondences
Maintains working knowledge of applicable regulations, policies and procedures.
Represents the office to internal and external customers as appropriate
Performs miscellaneous job-related duties as assigned.
Note: the duties listed above reflect the majority of the duties of this job and does not, nor is it intended to, reflect all duties that may be required for an incumbent in this job to perform.
Associates degree required or Bachelor's degree preferred with 2 – 5 years' experience that is related to the duties and responsibilities as specified OR 8 years of related experience in lieu of education.
A minimum of one year of related experience in a health care setting is required; three years of experience is preferred.
Healthcare claims experience preferred
Experience with data analysis and database queries as well as a solid understanding of technology systems preferred
General knowledge of program evaluation and data cleaning are preferred
Advanced working knowledge of Microsoft Office and databases preferred
Experience with credentialing software highly preferred.
Experience with SQL database administration preferred.
Professional Association; Affiliation and participation with the National Association Medical Staff Services or the Maine Association Medical Staff Services is preferred.
Regulatory Requirements: General understanding of National Committee for Quality Assurance (NCQA), Joint Commission and Healthcare Facilities Accreditation Program standards. State and federal licensure regulations, particularly as it relates to credentialing and provider data preferred.
Works in a normal office environment, requiring the ability to frequently respond to unpredictable situations. Time may be spent sitting at a computer, collaborating with other healthcare team members. Able to work sitting at work station, using a keyboard, working in front of a video display monitor most of the day.
Repetitive wrist and hand motion.
Extended use of telephone.
The ability to reach and stretch intermittently.
Moderate walking throughout the facility.
Lite lifting of files and manuals
Occasional long and irregular hours
Tolerance for frequent interruptions
Flexibility, dexterity, visual acuity, hearing acuity.
Must be able to speak and communicate clearly and effectively.
Must be able to adapt to frequently changing work priorities.
Must be able to travel to various member sites as there may be occasional travel for offsite meetings, education and/or conference(s).