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