credentialing analyst

Blue Cross and Blue Shield of Kansas City

<div><h2 class="jobSectionHeader">Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include:</h2><ul><li><h2 class="jobSectionHeader">
Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
</h2></li><li><h2 class="jobSectionHeader">Annual incentive bonus plan based on company achievement of goals</h2></li><li><h2 class="jobSectionHeader">
Time away from work including paid holidays, paid time off and volunteer time off</h2></li><li><h2 class="jobSectionHeader">
Professional development courses, mentorship opportunities, and tuition reimbursement program</h2></li><li><h2 class="jobSectionHeader">
Paid parental leave and adoption leave with adoption financial assistance</h2></li><li><h2 class="jobSectionHeader">
Employee discount program</h2></li></ul><h2 class="jobSectionHeader"> 

Job Description Summary:
</h2>The Senior Provider Business Analyst plays a critical leadership role in advancing the strategy, systems, and operations that support provider credentialing, contracting, and lifecycle management. This individual serves as a trusted advisor and subject matter expert, driving cross-functional initiatives that align provider processes with enterprise goals, regulatory requirements, and industry best practices. 
With a deep understanding of healthcare/payer operations, credentialing standards (e.g., NCQA, CMS, BCBSA), and provider data systems, the Senior Analyst leads the design and optimization of workflows, system configurations, and data governance strategies. This role partners closely with Provider Contracting, Reimbursement, IT, Compliance, and vendors to ensure provider lifecycle systems are scalable, compliant, and efficient.<h2 class="jobSectionHeader">
Job Description
</h2><ul><li>Lead and oversee large project implementations and upgrades of provider management platforms, ensuring seamless integration and alignment with organizational goals.</li><li>
Manage Business Data Governance Committee to instill data standards and accuracy</li><li>
Serve as a subject matter expert (SME) on provider management platforms, credentialing/contracting/directory data/provider relations workflows, and regulatory standards.</li><li>
Collaborate with cross-functional teams to design and implement scalable solutions that improve provider onboarding, data integrity, and operational efficiency.</li><li>
Manage vendors to adhere to SLA and performance measures to ensure compliance.</li><li>
Apply strong analytical and problem-solving skills to identify, analyze, and resolve complex business issues related to provider management.</li><li>
Monitor production and test environments, proactively identifying and resolving issues to ensure optimal system performance.</li><li>
Write efficient, insightful reports utilizing SQL to inform decision-making and monitor key performance indicators.</li><li>
Mentor junior analysts and contribute to the development of department policies, procedures, and training materials.</li><li>
Drive continuous improvement initiatives by leveraging data insights, stakeholder feedback, and industry trends.</li><li>
Support NCQA or URAC Accreditation efforts by maintaining high standards for provider network, data, and credentialing.</li></ul>
Minimum Qualifications<ul><li>
Bachelor&rsquo;s degree or an equivalent combination of education and experience.</li><li>
5+ years of experience in business analysis within a payer, with a focus on credentialing and provider data management.</li><li>
Expert with sPayer or other payer provider lifecycle/credentialing/contracting systems, CRM, and quality accreditation processes.</li><li>
Efficient report writer utilizing SQL</li><li>
Experience maintaining NCQA or URAC accreditation</li><li>
Proven ability to lead cross-functional initiatives and influence stakeholders at all levels.</li><li>
Strong analytical, problem-solving, and communication skills.</li><li>
Large project implementation or upgrade of provider management platforms.</li><li>
Proficiency in Microsoft Office applications.</li></ul>
Preferred Qualifications<ul><li>
Master&rsquo;s Degree in Information Systems, Data Management, Healthcare Administration or a related academic field</li><li>
Experience with Facets Claims software</li></ul>
Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.</div>

Provider Systems Business Analyst, Senior

Boston Neurobehavioral Associates

<div>
 
 
 
 Citadel Healthcare Management (PVT) LTD.
 
 provides healthcare management services for practices across North America. Our dedicated team supports a wide range of medical administration tasks, working collaboratively across multiple disciplines.
 
 
 
 
 Our mission is to offer employees meaningful opportunities to apply their expertise, grow in their careers, and contribute to the organization&rsquo;s ongoing success.
 
 
 
 
 We are committed to creating a workplace where employees feel valued, supported, and motivated. By fostering a collaborative and engaging environment, we ensure that every contribution is recognized and appreciated.
 
 
 
 
 At Citadel, diversity and inclusion are at the heart of our culture. We welcome individuals from all backgrounds&mdash;regardless of gender, ethnicity, age, religion, lifestyle, or disability&mdash;and embrace the unique perspectives and experiences they bring. Through teamwork, innovation, and continuous professional development, we empower our employees to thrive and drive progress within the organization.
 
 
 
 
 
 As
 
 Quality Assurance Analyst &ndash; RCM &amp; Credentialing
 
 - of CHM you will be liable to perform the following job duties:
 
 
 &nbsp;
 
 
 Essential Duties and Responsibilities:
 
 
 <ul>
 <li>
 
 Perform daily auditing of RCM accounts worked by staff to ensure accuracy based on QA policies and procedures
 
 </li>
 <li>
 
 Review credentialing files for accuracy, completeness, and compliance with state/federal regulations and internal policies
 
 </li>
 <li>
 
 Enter, update, and maintain or audit provider data within credentialing databases and tracking systems
 
 </li>
 <li>
 
 Gather and document general documentation issues for educational feedback purposes
 
 </li>
 <li>
 
 Maintain QA findings and complete monthly summary reports based on daily audit results, and distribute them to management
 
 </li>
 <li>
 
 Communicate quality deficiencies to staff and provide detailed feedback where necessary
 
 </li>
 <li>
 
 Identify and trend recurring errors and report them to management to support training and process improvement
 
 </li>
 <li>
 
 Work closely with department management to review and improve workflows and ensure account resolution efficiency
 
 </li>
 <li>
 
 Assist in the training of new staff related to QA policies and procedures
 
 </li>
 <li>
 
 Report payor issues, system issues, or staff-related issues to management
 
 </li>
 <li>
 
 Respond to inquiries from other departments as needed
 
 </li>
 <li>
 
 Ensure compliance with information systems security policies, attend required training, and report any security concerns
 
 </li>
 <li>
 
 Adhere to the company code of conduct, ethics policies, and compliance requirements,&nbsp;including reporting any violations appropriately
 
 </li>
 <li>
 
 Complete QA summary files and support overall QA reporting processes
 
 </li>
 <li>
 
 Support company values and perform other duties as assigned
 
 </li>
 </ul>
 <ul>
 <li>
 
 
 
 
 Benefits
 
 
 
 
 </li>
 <li>
 <ul>
 <li>
 <ul>
 <li>
 
 
 
 Provident Fund
 
 
 
 </li>
 <li>
 
 
 
 Leave Encashment
 
 
 
 </li>
 <li>
 
 
 
 Gratuity
 
 
 
 </li>
 <li>
 
 
 
 Health Insurance
 
 
 
 </li>
 <li>
 
 
 
 Inflation Bonus
 
 
 
 </li>
 <li>
 
 
 
 Housing Allowance
 
 
 
 </li>
 <li>
 
 
 
 Patient seen Bonus
 
 
 
 </li>
 <li>
 
 
 
 Eid Bonus
 
 
 
 </li>
 </ul>
 </li>
 </ul>
 </li>
 </ul>
 
 Salary:
 
 
 60,000PKR - 80,000PKR
</div>

Quality Assurance Analyst – RCM & Credentialing Medical Billing USA

Boston NeuroBehavioral Associates

<div><div>Citadel Healthcare Management (PVT) LTD. provides healthcare management services for practices across North America. Our dedicated team supports a wide range of medical administration tasks, working collaboratively across multiple disciplines.
Our mission is to offer employees meaningful opportunities to apply their expertise, grow in their careers, and contribute to the organization&rsquo;s ongoing success.
We are committed to creating a workplace where employees feel valued, supported, and motivated. By fostering a collaborative and engaging environment, we ensure that every contribution is recognized and appreciated.
At Citadel, diversity and inclusion are at the heart of our culture. We welcome individuals from all backgrounds&mdash;regardless of gender, ethnicity, age, religion, lifestyle, or disability&mdash;and embrace the unique perspectives and experiences they bring. Through teamwork, innovation, and continuous professional development, we empower our employees to thrive and drive progress within the organization. 
As Quality Assurance Analyst &ndash; RCM &amp; Credentialing - of CHM you will be liable to perform the following job duties: 
Essential Duties and Responsibilities:<ul><li>
Perform daily auditing of RCM accounts worked by staff to ensure accuracy based on QA policies and procedures</li><li>
Review credentialing files for accuracy, completeness, and compliance with state/federal regulations and internal policies</li><li>
Enter, update, and maintain or audit provider data within credentialing databases and tracking systems</li><li>
Gather and document general documentation issues for educational feedback purposes</li><li>
Maintain QA findings and complete monthly summary reports based on daily audit results, and distribute them to management</li><li>
Communicate quality deficiencies to staff and provide detailed feedback where necessary</li><li>
Identify and trend recurring errors and report them to management to support training and process improvement</li><li>
Work closely with department management to review and improve workflows and ensure account resolution efficiency</li><li>
Assist in the training of new staff related to QA policies and procedures</li><li>
Report payor issues, system issues, or staff-related issues to management</li><li>
Respond to inquiries from other departments as needed</li><li>
Ensure compliance with information systems security policies, attend required training, and report any security concerns</li><li>
Adhere to the company code of conduct, ethics policies, and compliance requirements, including reporting any violations appropriately</li><li>
Complete QA summary files and support overall QA reporting processes</li><li>
Support company values and perform other duties as assigned</li></ul></div><ul><li><div>
Benefits</div></li><li><div><ul><li><div><ul><li>
Provident Fund</li><li>
Leave Encashment</li><li>
Gratuity</li><li>
Health Insurance</li><li>
Inflation Bonus</li><li>
Housing Allowance</li><li>
Patient seen Bonus</li><li>
Eid Bonus</li></ul></div></li></ul></div></li></ul>
Salary: 
60,000PKR - 80,000PKR
Oj5ntTc4wd</div>

Oncology Nursing Society

<div>Credentialing Administrator 
Oncology Nursing Certification Corporation (ONCC&reg;) 
Remote | Full-Time 
Make a Difference That Matters
ONCC&reg; is the premier provider of nationally accredited certification for nurses in oncology and related specialties. Founded in 1984 as a non-profit organization, ONCC administered the first Oncology Certified Nurse (OCN&reg;) examination in 1986. Today, ONCC offers multiple credential programs, has more than 42,000 currently certified nurses and provides management services for the Board of Oncology Social Work Certification (BOSWC&reg;). Learn more at oncc.org. 
 
The Opportunity
The Credentialing Administrator serves as an eligibility and verification expert for ONCC certification programs. Processes a high volume of applications for all ONCC and BOSWC certification programs, including oncology nursing and related specialties, and oncology social work. The Credentialing Administrator will review and evaluate candidate eligibility in compliance with policies, established service levels, and national accreditation standards.
What You&rsquo;ll Do<div><ul><li>
Review, evaluate, and determine eligibility/compliance for credentialing program applications.</li><li>
Audit and verify documentation (e.g., transcripts, continuing education, practice hours, job descriptions, learning plans and licenses) to ensure program integrity.</li><li>
Coordinate BOSWC application review with volunteer reviewers and ensure timely, well-documented decisions, and provide BOSWC program support.</li><li>
Provide customer support via phone/email on eligibility and policies; provide Tier 1 technical support for credentialing systems and vendor sites.</li><li>
Support the Director of Operations and Operations Team with administrative and customer support duties as needed.</li><li>
Demonstrate and support a culture of diversity, equity, inclusion, and connection.</li></ul></div>
What You Bring 
Required<div><ul><li>
Bachelor&rsquo;s degree in business administration, business management, communications, or related field.</li><li>
3&ndash;5 years&rsquo; experience in a customer relations representative or credentialing role.</li><li>
Strong knowledge of Microsoft Office (e.g., Excel, Word) and certification management/reporting software.</li><li>
Strong knowledge of credentialing management systems.</li><li>
Experience applying/enforcing certification program requirements.</li><li>
Proven ability to make effective independent decisions.</li><li>
Working knowledge of HIPAA and FERPA compliance/violations.</li><li>
Excellent organizational and time management skills; ability to write, read, and interpret SOPs, transcripts, and similar documentation.</li></ul></div>
Preferred<div><ul><li>
3 &ndash; 5 years working in credentialing, preferably in nursing or other healthcare field (An equivalent combination of education, training, and experience may be considered in lieu of degree requirements).</li><li>
Working knowledge of video conferencing software (e.g., Zoom).</li><li>
Knowledge of oncology nursing and/or oncology social work terminology, degrees, licensure, continuing education accreditation and testing accommodations.</li><li>
Institute for Credentialing Excellence Credentialing Specialist Certificate (held or gained within the first 24 months in the position).</li></ul></div>
Work Environment &amp; Travel<div><ul><li>
Full-time, remote (work-from-home) position.</li><li>
Occasional travel to ONCC offices in Pittsburgh, PA throughout the year is required.</li></ul></div>
Compensation &amp; Benefits
We use a market-based approach to compensation, considering experience, qualifications, and market conditions.
Anticipated Pay Range: $50,999 - $61,199 annually
Benefits include:<div><ul><li>
Tuition Reimbursement/Continuing Education Allowance</li><li>
Flexible schedules</li><li>
Generous paid time off</li><li>
Health and dental benefits</li><li>
Computer Purchase Loan Program</li><li>
Pet Insurance</li><li>
Retirement Savings Plan (401k) after 30 days</li><li>
Travel opportunities</li></ul></div>
Our Commitment to Inclusion
ONS is an Equal Opportunity and Affirmative Action Employer. We value diversity, equity, and inclusion and are committed to building a workplace that reflects a broad range of backgrounds, perspectives, and experiences. All qualified applicants are encouraged to apply.</div>

Credentialing Administrator

Prima Systems

We are seeking a detail-oriented and experienced Credentialing and Enrollment Associate to join our medical billing team. The ideal candidate will have a strong background in healthcare credentialing and enrollment processes, particularly within the US healthcare system. This role will involve ensuring that healthcare providers are properly credentialed with insurance networks and government programs, facilitating enrollment, and maintaining accurate records.Responsibilities:<ul><li>Manage the credentialing and enrollment process for healthcare providers with insurance networks, Medicare, Medicaid, and other relevant programs.</li><li>Prepare and submit credentialing applications, re-credentialing, and revalidation documents accurately and timely.</li><li>Ensure compliance with all credentialing requirements, regulations, and standards set by accrediting bodies and government agencies.</li><li>Communicate with insurance companies, providers, and internal stakeholders to resolve credentialing issues and inquiries.</li><li>Maintain up-to-date knowledge of current healthcare regulations, policies, and procedures related to credentialing and enrollment.</li><li>Coordinate with internal departments to gather necessary documents and information for credentialing applications.</li><li>Monitor the status of applications, track expirations, and follow up on pending items to ensure timely completion.</li><li>Maintain accurate and organized credentialing and enrollment records, both electronic and paper-based.</li><li>Assist in audits and reviews related to credentialing and enrollment processes.</li></ul>Requirements:<ul><li>Graduation is mandatory.</li><li>Minimum of 06 months of experience in healthcare credentialing and enrollment, preferably in a medical billing setting.</li><li>In-depth knowledge of credentialing processes for insurance networks, Medicare, Medicaid, and other payers.</li><li>Familiarity with CAQH, NPI, UPIN, and other relevant healthcare databases and identifiers.</li><li>Strong understanding of healthcare regulations, compliance standards, and HIPAA guidelines.</li><li>Excellent English communication skills, both verbal and written, with the ability to interact professionally with providers and insurance representatives.</li><li>Exceptional attention to detail, accuracy, and organizational skills.</li><li>Proficiency in using MS Office applications and credentialing software.</li><li>Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.</li></ul>Job Type: Full-timePay: Rs60,000.00 - Rs75,000.00 per monthApplication Question(s):<ul><li>Are you available for night shift</li></ul>Experience:<ul><li>Credentialing in Medical Billing: 1 year (Preferred)</li></ul>Language:<ul><li>English (Preferred)</li></ul>Work Location: In person

Credentialing Associate

HA-Technologies

WE ARE HIRINGCredentialing Specialist on urgent basis.━━━━━━━━━━━━━Company: MedxCode LLC.Location: Blue Area, IslamabadExperience: minimum 2 YearsKey Responsibilities:* Submitting credentialing applications for healthcare providers.* Follow-up with insurance companies regarding application status.* Managing and updating CAQH profiles.* Performing CAQH Attestation.* Ensuring all provider documents are complete and accurate.Perks &amp; Benefits:* Competitive salary package.* Friendly and professional work environment.* Learning and career growth opportunities.* Paid leaves as per company policy.Application Question(s):<ul><li>How many years of experience do you have in medical credentialing?</li><li>Do you have hands-on experience with CAQH profile management and attestation? (Yes/No)</li><li>Have you previously worked with US healthcare credentialing processes? (Yes/No)</li><li>Can you handle credentialing applications submission and follow-ups with insurance companies independently? (Yes/No)</li><li>Which credentialing software/tools have you used?</li><li>Are you familiar with insurance panels and provider enrollment processes? (Yes/No)</li><li>How soon can you join?</li><li>What is your expected salary?</li></ul>Work Location: In person

Credentialing Specialist

We are seeking a detail-oriented and experienced Credentialing and Enrollment Associate to join our medical billing team. The ideal candidate will have a strong background in healthcare credentialing and enrollment processes, particularly within the US healthcare system. This role will involve ensuring that healthcare providers are properly credentialed with insurance networks and government programs, facilitating enrollment, and maintaining accurate records.Responsibilities:<ul><li>Manage the credentialing and enrollment process for healthcare providers with insurance networks, Medicare, Medicaid, and other relevant programs.</li><li>Prepare and submit credentialing applications, re-credentialing, and revalidation documents accurately and timely.</li><li>Ensure compliance with all credentialing requirements, regulations, and standards set by accrediting bodies and government agencies.</li><li>Communicate with insurance companies, providers, and internal stakeholders to resolve credentialing issues and inquiries.</li><li>Maintain up-to-date knowledge of current healthcare regulations, policies, and procedures related to credentialing and enrollment.</li><li>Coordinate with internal departments to gather necessary documents and information for credentialing applications.</li><li>Monitor the status of applications, track expirations, and follow up on pending items to ensure timely completion.</li><li>Maintain accurate and organized credentialing and enrollment records, both electronic and paper-based.</li><li>Assist in audits and reviews related to credentialing and enrollment processes.</li></ul>Requirements:<ul><li>Minimum of 2-3 years of experience in healthcare credentialing and enrollment, preferably in a medical billing setting.</li><li>In-depth knowledge of credentialing processes for insurance networks, Medicare, Medicaid, and other payers.</li><li>Familiarity with CAQH, NPI, UPIN, and other relevant healthcare databases and identifiers.</li><li>Strong understanding of healthcare regulations, compliance standards, and HIPAA guidelines.</li><li>Excellent English communication skills, both verbal and written, with the ability to interact professionally with providers and insurance representatives.</li><li>Exceptional attention to detail, accuracy, and organizational skills.</li><li>Proficiency in using MS Office applications and credentialing software.</li><li>Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.</li></ul>Job Type: Full-timePay: Rs100,000.00 - Rs130,000.00 per monthApplication Question(s):<ul><li>Are you available for night shift</li></ul>Experience:<ul><li>Credentialing in Medical Billing: 1 year (Preferred)</li></ul>Language:<ul><li>English (Preferred)</li></ul>Work Location: In person

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3808 credentialing analyst jobs Near Me

Provider Systems Business Analyst, Senior

Quality Assurance Analyst – RCM & Credentialing Medical Billing USA

Quality Assurance Analyst – RCM & Credentialing Medical Billing USA

Credentialing Administrator

Credentialing Associate

Credentialing Specialist

Credentialing Specialist