Provide key support and analysis to the provider enrollment credentialing process which directly impact the ability of AtlantiCare to bill for services rendered by billable providers, thereby directly impacting AtlantiCare revenue generation for providers.  The framework for provider enrollment credentialing includes compliance in an increasingly complex regulatory environment defined by The Joint Commission, Department of Health, and National Committee for Quality Assurance and Centers for Medicare and Medicaid standards.

The Compliance Analyst will audit 100% of credentialing and reappointment (re-credentialing) files submitted by Credentialing Specialists to ensure compliance with National Committee for Quality Assurance (NCQA), The Joint Commission (TJC) accreditation and other regulatory standards, internal policies and procedures and managed care plan requirements.  The Analyst will also audit data entered in the Credentialing database for completeness, accuracy, consistency, gaps, etc.  This position will perform all necessary follow-up activities related to audit errors to ensure that corrections have been made appropriately and will serve as subject matter expert and coach for the Credentialing Specialists.   

This position supports organizational goals by providing quality customer service, participating in performance improvement efforts and demonstrating a commitment to teamwork and cooperation

QUALIFICATIONS

EDUCATION:  Bachelor’s degree preferred.

LICENSE/CERTIFICATION:

EXPERIENCE:  5 years in healthcare or NCQA, managed care environment and/or related experience. Experience with computer spreadsheet, database, and audit software literacy.  Analytical skills, ability to define problems, collect data, establish facts, and draw valid conclusions.  Strong written and verbal communication.  Proficiency in application of audit theory, standards, procedures and techniques.  Ability to interpret and apply department policies and procedures.