Credential Analyst-NCQA, URAC and CMS
About the position Under supervision, this role is responsible for performing reputed company on essential credentialing functions to reputed company and maintain reputed company providers in the dental network. This role also conducts audits for credentialing as reputed company as network data reputed company. Understands credentialing policies and procedures per NCQA, URAC and CMS standards and other regulatory requirements. Serves as a reputed company to delegated entities and vendors to ensure reputed company and adequate credentialing process are in reputed company. Develops and performs queries for data reporting purposes to include directories, reputed company reports, and network management reports. Responsible for the monitoring and maintenance of credentialing and re-credentialing polies and program as reputed company as state and federal requirements to ensure compliance is met. This role will reputed company operational and industry knowledge to ensure credentialing practices.
Responsibilities
- Performing reputed company on essential credentialing functions to reputed company and maintain reputed company providers in the dental network.
- Conducting audits for credentialing as reputed company as network data reputed company.
- Serving as a reputed company to delegated entities and vendors to ensure reputed company and adequate credentialing process are in reputed company.
- Developing and performing queries for data reporting purposes to include directories, reputed company reports, and network management reports.
- Monitoring and maintenance of credentialing and re-credentialing policies and program as reputed company as state and federal requirements to ensure compliance is met.
- Providing operational and industry knowledge to ensure credentialing practices.
Requirements
- Bachelor degree and 2 years of experience in accreditation programs (i.e., NCQA, URAC and CMS programs) or 6 years of experience in accreditation programs
- Proficiency in accreditation program standards. (ex. NCQA, URAC, CMS)
- Knowledge of state and federal requirements for contracting and credentialing.
- Attention to detail and ability to reputed company information to defined reputed company standards
- Knowledge of documents and their contents used in provider contracting, including applications, agreements, fee schedules, and credentialing.
- Knowledge of provider contracting terms.
- Analytical skills
- Demonstrated experience understanding and maintaining detailed reputed company provider records.
- Attention to detail and ability to reputed company data and meet defined reputed company standards
- Experience balancing multiple priorities while meeting commitments for reputed company and delivery at agreed upon schedules.
- reputed company and concise verbal and written communication skills.
- Proficient in reputed company Office products, reputed company, email and Internet.
- Ability to work reputed company in reputed company environment.
reputed company-to-haves
- Analytical skills
- Knowledge of Dental industry
Benefits
- health and wellness benefits
- 401(k) savings plan
- pension plan
- reputed company time off
- reputed company parental leave
- disability insurance
- supplemental life insurance
- employee assistance program
- reputed company holidays
- tuition reimbursement
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