PAYOR CREDENTIALING ANALYST

Overview

The Payor Credentialing Analyst oversees the enrollment process for employed providers within Covenant HealthCare. He/she role models excellent customer service; his/her attitude and actions are at all times consistent with the standards contained in the Mission, Vision, and Values of Covenant Healthcare and the commitment to Extraordinary Care for Every Generation. The Payor Credentialing Analyst will treat providers who are going through the enrollment/credentialing process as they are our customers, therefore providing excellent customer service to them. Functions include but are not limited to: building relationships and support to new providers, building strong mutually beneficial relationships with Covenant HealthCare staff that are also involved in the provider credentialing process, data and document collection, assisting with completion of applications and enrollment documents, monitoring payor enrollment and maintain accurate computerized records.
Responsibilities

Contributes to organization and department success targets for net operating margin
Assures timely completion of provider enrollment with all payors
Models Covenant�s Mission, Vision and Values of keeping our commitment to Extraordinary Care for Every Generation
Demonstrates excellent customer service skills
Initiates communication with newly hired providers and proactively updates the provider and manager when issues arise within the enrollment/credentialing process
Facilitates collection of documents from provider for enrollment/credentialing process
Provides assistance to the provider regarding the enrollment/credentialing process
Works with Medical Staff Services and Covenant HealthCare Partners to assure seamless enrollment process
Maintains acceptable customer relationships with payor representatives and assures data, documents and signatures are accurate for the enrollment/credentialing process
Adheres to all rules/regulations and quickly responds to changes within the payor arena to assure timely enrollment
Serves as delegated official to enroll providers in governmental programs
Performs revalidation processes with CAQH and individual payors
Prepares enrollment reports as required
Prioritizes issues and workload effectively
Identify and alert management of any situation that may negatively impact the enrollment/credentialing process
Maintain a high level of confidentiality of provider information
Maintains open communication and create a positive work environment
Works together with other departments to accomplish common goals
Possesses excellent communication skills to effectively perform essential duties of job


Qualifications

EDUCATION/EXPERIENCE
Associates Degree in Business, Office Management or related field
Three to five years previous experience with provider enrollment, credentialing and/or provider billing

KNOWLEDGE/SKILLS/ABILITIES
Strong working knowledge of Third Party Billing and Provider Enrollment/Credentialing
Computer competency
Minimal typing skills of 35 words/ minute. Prefer a strong working knowledge of Excel, Word, PowerPoint
Demonstrated organizational skills and strong follow up skills
Possess excellent oral and written communication skills
Ability to prioritize and work independently
Ability to communicate with diverse population
Ability to protect and maintain the confidential nature of information

WORKING CONDITIONS/PHYSICAL DEMANDS
Ability to maintain punctual attendance consistent with the ADA, FMLA, and other federal, state, and local standards.
Constant hearing.
Frequent lifting up to 25 lbs.
Frequent standing, walking, sitting, pushing, pulling, twisting, reaching, handling, fingering and talking.
Occasional lifting up to 50 lbs.
Occasional lifting, carrying, climbing, balancing, stooping, kneeling, crouching, squatting and feeling.
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