Credentialing Analyst supports the credentialing program
that implements federal, state and local regulatory and NCQA accreditation requirements. Ensures that all practitioners and facilities are evaluated upon entry into the PCHP network and conducts an ongoing review of the providers. Gathers, analyzes, and report provider data for the provider directory, billing
needs, and member support. Communicates with providers and provider groups to answer their questions and concerns or direct to the proper department. Assists with oversight audits of delegated and non-delegated providers. Responsibilities : - Builds and maintains relationships with external vendors and credentialing partners including
Aperture & Texas Association of Health Plans - Administrates reports in external database portals & analyze data, confirm accuracy, and present
to internal department. - Assists with the oversight of the delegated and non-delegated provider and facility’s data.
- Gathers, analyzes, and reports provider data to internal and external customers.
- Ensures that all practitioners and facilities are evaluated upon entry into the PCHP network and
conducts an ongoing review of the providers. - Identifies opportunities for improvement through the audit process and provide recommendations.
- Accurately tracks, reports, and follows up on the status of credentialing applications.
- Maintains a strict degree of confidentiality in all areas relating to provider credentials, status and
provider personal information. - Familiar with state specific all credentialing department policies and procedures.
- Assist with miscellaneous audits projects throughout the year as required.
- Communicates with Credentialing Manager regarding any or all credentialing delays or issues.
- Other duties as assigned.
Job Accountabilities 1. Identifies ways to improve work processes and improve customer satisfaction. Makes
recommendations to supervisor, implements, and monitors results as appropriate in support of the
overall goals of PCHP. 2. Stays abreast of the latest developments, advancements, and trends in the field by attending
seminars/workshops, reading professional journals, actively participating in professional
organizations, and/or maintaining certification or licensure. Integrates knowledge gained into
current work practices. 3. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the
area. Develops effective internal controls designed to promote adherence with applicable laws,
accreditation agency requirements, and customer requirements. Seeks advice and guidance as
needed to ensure proper understanding. Skills or Special Abilities
• - Advanced proficiency in Microsoft Excel to include Vlookup, creating complex function and
equations. - Strong interpersonal, problem solving and relationship building skills with positive attitude and
demeanor. - Ability to take initiative to research and form conclusions independently.
- Ability to manage multiple deadlines and time constraints in a fast-paced environment.
- Demonstrated ability to collaborate effectively and work as part of a team including internal and
external stakeholders. - Ability to perform detail work efficiently and with a high degree of accuracy.
- Clear and professional verbal and written communication skills with the ability to clearly explain
complex processes. - Skilled in interpreting, analyzing, and providing recommendations regarding data accuracy and
data collection needs and processes. - Excellent planning, organization, time management, and documentation skills.
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