Logo for ICONMA

*Analyst I - Provider Credentialing - QC Analyst

ICONMA

Role overview

Qualifications

  • 3+ years of related health care or health plan experience in credentialing compliance, auditing, and quality assurance
  • Proficient in Microsoft Office Applications; Excel, Outlook, Word, and Teams
  • The ability to create spreadsheets, analyze data and identify trends
  • Strong attention to detail and the ability to multi-task in a fast-paced environment

Responsibilities

  • Supports the credentialing compliance monitoring program activities, auditing, data collection, trend analysis and meeting timeliness for delegated payer deliverables
  • Assists in the preparation of deliverables for payer and internal audit requests
  • Building and maintaining effective, positive internal and external customer relationships
  • Conducting ongoing monitoring to evaluate levels of regulatory credentialing and delegated payer compliance with contractual and requirements

Key facts

Hard skills

Auditing Medical Practice Experience Customer Relationship Management Project Management

Other skills

  • Microsoft Office
  • Microsoft Excel
  • Detail Oriented
  • Communication

About the company

ICONMA logo

ICONMA

Human Resources, Staffing & Recruiting

We provide Professional Staffing Services & Project-Based Solutions for a broad range of Fortune 500 organizations. ICONMA is a certified Woman-Owned staffing company and was founded in 2000. ICONMA’s corporate headquarters is in Troy, Michigan, and has 15+ locations worldwide. What makes ICONMA stand out in a fiercely competitive industry? *We provide integrated, full lifecycle services across a broad range of business and technical platforms. *No single company can duplicate our full range of staffing and permanent recruiting services nationwide. *Proven track record of attracting and retaining exceedingly skilled professional workers in a highly competitive market. SERVICES OFFERED Staff Augmentation (Contract, Contract to Hire, Direct Hire, Single Source) Data Analysis Project-Based Services & Solutions Hire Train Deploy Service Model Offshore Staff Augmentation Payroll Services AREAS OF EXPERTISE - Information Technology - Engineering - Business Professional - Accounting/Finance - Admin/Clerical/Call Center - Healthcare/Clinical/Scientific - Marketing/Creative mail linkedin@iconma.com Phone (888) 451-2519 Website http://www.iconma.com

Company details

Company typeLarge
IndustryHuman Resources, Staffing & Recruiting
Company size1001 - 5000

Links

Website LinkedIn See all jobs

Your match analysis

See how your profile stacks up against this role.

We compared the job requirements to your profile to show where you're strong and where you fall short.

Job description

Our client, a Retail Pharmacy company, is looking for a Analyst I - Provider Credentialing - QC Analyst for their QC Analyst location.
 
Responsibilities:
  • This position supports the credentialing compliance monitoring program activities, auditing, data collection, trend analysis and meeting timeliness for delegated payer deliverables.
  • Assists in the preparation of deliverables for payer and internal audit requests
  • Assist with credentialing tasks as needed
  • Building and maintaining effective, positive internal and external customer relationships
  • Conducting ongoing monitoring to evaluate levels of regulatory credentialing and delegated payer compliance with contractual and requirements
  • Exhibiting client Heart at Work Behaviors
  • Participating in team initiatives and projects and meeting deadlines and quality expectations
  • Participates in the development and ongoing implementation of quality improvement activities.
  • Improve quality products and services, by using measurements and analysis to process, evaluate and make recommendations to meet QM compliance objectives
  • Performing credentialing business process functions as needed, performing scheduled and random credentialing file audits
  • Reviewing risk assessments while participating in ongoing monitoring and annual program evaluation and identification of areas where there can be process improvement
  • Developing and maintaining an in-depth working knowledge of contractual, regulatory, and program policy related obligations
  • Participates in the development and ongoing implementation of quality improvement activities. Improve quality products and services, by using measurements and analysis to process, evaluate and make recommendations to meet QM compliance objectives
  • Conducting ongoing monitoring to evaluate levels of regulatory credentialing and delegated payer compliance with contractual and requirements
  • Performing business process and credentialing documentation audits
  • Reviewing risk assessments while participating in ongoing monitoring and annual identification of areas where there can be process improvement
  • This position supports the credentialing compliance monitoring program activities and deliverables.
  • The position is responsible for:
  • Creating spreadsheets with formulas to track and trend data
  • Developing and maintaining an in-depth working knowledge of contractual, regulatory, and program policy related obligations
  • Participates in the development and ongoing implementation of quality improvement activities.
  • Improve quality products and services, by using measurements, data and trend analysis to process, evaluate and make recommendations to meet credentialing QM compliance objectives
  • Conducting ongoing monitoring to evaluate levels of regulatory credentialing and delegated payer compliance with contractual and requirements
  • Performing business process and credentialing documentation reviews and audits
  • Building and maintaining effective, positive internal and external customer relationships
  • Professional and clear communication and presentation of findings
  • Working with minimal supervision and able to effectively manage and prioritize multiple projects simultaneously
 
Requirements:
  • 3+ years of related health care or health plan experience in credentialing compliance,
  • auditing, and quality assurance
  • Proficient in Microsoft Office Applications; Excel, Outlook, Word, and Teams
  • The ability to create spreadsheets, analyze data and identify trends.
  • Strong attention to detail and the ability to multi-task in a fast-paced environment
  • MD Staff experience is preferred
  • Bachelor’s Degree (preferred)
  • Verifyable High School Diploma or GED Required
 
Why Should You Apply?

Apply once. Then go straight to the hiring manager.

After you apply, unlock the direct contact details of the people who actually make the call. A quick follow-up makes you 5x more likely to land an interview.

MR

Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
Unlocked after you apply
·

Financial Analyst Related jobs

Rhode Island (USA)Financial Analyst

Other jobs at ICONMA

Premium

Reach out to the hiring manager directly.

Gain access to the contact details of the hiring managers who actually decide, and reach out to network with them directly. That, plus more when you upgrade:

  • Full match report with fit score and gaps
  • Career diagnostics on how recruiters read you
  • Curated company matches and warm intros
  • 48h early access to new roles

Cancel anytime.