Credentialing Analyst

Position Highlights:

• The Credentialing Analyst will perform a variety of analytical, project management and reporting tasks to facilitate and enhance the effective performance of the revenue cycle process.
• Job responsibilities will include initial implementation of electronic Medicare and Medicaid credentialing databases, ensuring that taxonomy codes are accurate in the patient accounting system, and updates are communicated to the managed care department.
• The position will involve frequent oral and written communication with providers.

Responsibilities:

• Utilizes web portals and electronic filing methods and maintains detailed data bases for Medicare and Medicaid credentialing and recredentialing. Leads in the implementation of software to track and update enrollment status
• Establishes electronic reporting and monitoring for the Revenue Cycle area, including data submission, follow-up, and reporting findings to management
• Researches and compiles summaries of changes in CMS reimbursement
• Works with the managed care department to obtain proposed payer fee schedules and analyzes current charges to ensure MMG is optimizing reimbursement. Implements approved changes in the MMG charge master.

Credentialing and Experience:

• Associates Degree – field of study: Business, Healthcare or related field
• Minimum of two (2) years' experience in data analysis/reporting relative to physician, hospital, healthcare or managed care information.
• • *In lieu of Associates degree a High School Diploma/GED plus four (4) years’ experience as stated above will be considered.

Preferred Exp:

• Medicare and Medicaid credentialing experience
• Experience with MD Staff software