Sr Analyst Provider Data ManagementCredentialing
Sr Analyst Provider Data ManagementCredentialing
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Job Description
Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a differenceworkingin everything from scrubs to jeans.
Are we growing Absolutely and Globally. In 2021 we grew our teams by almost 50 and continue to grow even more in we recognized as a company you are supported by for your career and growth and a great place to workDefinitely. Evolent Health International (Pune India) has been certified as Great Places to Work in 2021. In 2020 and 2021 Evolent in the U.S. was both named Best Company for Women to Advance list by and earned a perfect score on the Human Rights Campaign (HRC) Foundations Corporate Equality Index (CEI). This index is the nations foremost benchmarking survey and report measuring corporate policies and practices related to LGBTQ workplace equality.
We recognize employees that live our values give back to our communities each year and are champions for bringing our whole selves to work each day. If youre looking for a place where your work can be personally and professionally rewarding dont just join a company with a mission. Join a mission with a company behind it.
What Youll Be Doing:
The Analyst Credentialing Operations (PDM) will be a dynamic role that will encompass determining provider types who require credentialing initiating the Primary Source Verification Process (PSV) performing provider outreach and administrative auditing. This position reports to the Associate Director Credentialing Operations.
Collaboration Opportunities:
The Analyst Credentialing Operations team(PDM) collaborates with the Provider Data Management (PDM)team through our Jira ticking system.
What You Will Be Doing:
- Maintenance of provider data within the credentialing platform
- Ticket intake and triage for internal/externally submitted tickets.
- Responsible for credentialing and recredentialing files including both Type I and Type II files.
- Maintain working knowledge of and comply with NCQA credentialing and recredentialing guidelines.
- Maintain working knowledge of and comply with partner specific credentialing and recredentialing guidelines policies and procedures.
- Ongoing monthly monitoring of exclusions sanctions and adverse events
- Represent Credentialing department in meetings and delivering special projects and maintaining concurrent projects as assigned.
- Establishing and maintaining excellent relationships internally and externally including communication to the leadership team.
- Maintain contractual service level and/or operational level agreements as applicable.
Qualifications Required and Preferred:
- Bachelors Degree or equivalent years of work experienceRequired.
- Excellent verbal and written communication skills Required.
- Detail oriented with good organizational skillsRequired.
- Ability to work in an agile space and adapt to fluctuating situationsRequired.
- Takes initiative and works independently Required.
- Ability to time manage and reprioritize tasks/projects as appropriate Required.
- Microsoft Office Suite including Word Excel PowerPoint OutlookRequired.
- Minimum of two to three years experience in healthcare field related to credentialing provider enrollment provider services and/or configurationPreferred.
- General understanding of US health care Managed Care Organizations Medicare and/or MedicaidPreferred.
Mandatory Requirements:
Employees must have a highspeed broadband internet connection with a minimum speed of50 Mbpsand the ability to set up a wired connection to their home network to ensure effective remote work. These requirements may be updated as needed by the business.
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race color religion sex sexual orientation gender identity national origin veteran status or disability status.
Required Experience:
Senior IC
Employment Type
Full-Time
