Job Description

Our Mission:  Provide the best value in health insurance and related health services to improve the quality of life for Arizonans.

Our Vision: 

Inspire health in Arizona as the trusted leader in delivering affordable, innovative healthcare solutions.

Our Benefits: Our benefits provide work-life balance and the flexibility you need to be your best. We offer comprehensive medical, dental, and vision coverage; a 401K savings plan; paid holidays and vacations; and much more!

Position Purpose:  Reporting to the Director of Credentialing, the Credentialing Data Analyst facilitates the accurate provider demographic data entry into the eVIPs application and claims database (Med/MC and QNXT), ongoing maintenance of credentialing information within the provider directory, and accurate transmission of data both internally and externally in compliance with regulatory and NCQA guidelines.

Responsibilities:

  • Streamline and normalize existing provider address records for data entry into the eVIPs application
  • Collect information and details on providers that require demographic information to be updated or added to the system, including researching and requesting those changes and/or updates.
  • Ensure that all paper and/or electronic forms are accurate and have the appropriate documents attached for loading into company systems.
  • Provide timely daily updates to various departments of any provider changes to facilitate downstream system updates; to include AHCCCS daily deliverable
  • Analyze existing provider data to confirm accuracy of data converted
  • Code delegated credentialing roster for import in the eVIPs application, conduct import, and monitor for downstream system loads
  • Ensure data appearing in provider directories and other materials for members is consistent with credentialing data in accordance with NCQA CR standards
  • Identify discrepancies in provider practice information and facilitate timely terminations prior to recredentialing event
  • Ensure updates to provider demographic data, including address changes and terminations, occurs within 30 days of notification
  • Provide recommendations and feedback regarding process improvements and/or standardization practices
  • Actively participate in staff meetings, team huddles, and one-on-one meetings
  • Engage in team building activities
  • On-going Coordination with Reimbursement Services, ensuring timely delivery of current updates
  • Other duties as assigned

Education / Experience / Other Requirements

Education:   

  • High School Diploma
  • Certification in coding or credentialing preferred (or equivalent combination of education and experience)

Years of Experience:  

  • A minimum of two years of relevant work experience in a healthcare field, preferably within a managed care or provider practice setting

Specialized Knowledge:  

  • Thorough understanding of managed care principles and physician practice operations, with an understanding of managed care credentialing and/or demographic maintenance preferred
  • Comprehensive understanding of and significant experience using Microsoft Excel
  • Ability to efficiently manipulate and manage large data sets
  • Experience with a relational database preferred
  • Experience in a scripting language, such as SQL or Microsoft Access preferred

Skills & Abilities:

  • Ability to think critically
  • Strong attention to detail, organizational skills, and verbal and written communication skills
  • Outstanding interpersonal skills, ability to establish a trusting rapport with individuals at all levels
  • Maintains confidentiality according to policy
  • Accurately review data and figures both in hard copy and electronic formats
  • Accurately sort through data and think through issues in a time-pressured environment
  • Focus on a specific event or activity for up to four (4) hours at a time without interruption
  • Maintain a calm and collected presence while addressing the concerns from an internal and external customer
  • Accurately learn and retain new information, knowledge and skills
  • Efficiently manage multiple tasks, with varying degrees of priority, at the same time

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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