Credentialing Analyst

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