Credentialing Data Analyst

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

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