Senior Credentialing Compliance Analyst (Hybrid) - (PA/NJ/DE)
Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole- person health.
Job Summary Responsible for all activities involving quality oversight and compliance with applicable accreditation and regulatory requirements; conducts audits and analyzes data and documentation.
Responsibilities: As a part of the Quality Management team, the Senior Credentialing Compliance Analyst implements policies related to practitioner and ancillary credentialing for all provider types. This includes adherence to procedures for ongoing monitoring of practitioner sanctions, complaints, and quality issues between recredentialing cycles and taking appropriate action when it identifies occurrences of poor quality. Implementation incudes ongoing monitoring of providers by surveilling practitioner sanctions (inclusive of Medicare and Medicaid sanctions, state sanctions, restrictions on licensure, and/or limitations on scope of practice), complaints, and quality issues on an ongoing basis and initiating appropriate action based on these reviews. This includes assessment of legislation in PA and surrounding states, all state licensing bureaus, CMS standards and NCQA requirements.
Dedicated to analyzing reports to identify high-risk, high-volume, and problem-prone processes to mitigate risk. Performs follow up analysis of reports to determine accuracy of data components. Formulates recommendations based on best practices and cross-functional business operations and collaborates with business area to execute follow up of corrective action plans. Develops and maintains corporate credentialing business decisions as needed.
Qualifications
Experience, Knowledge, & Skills
Minimum of 3 years’ experience in one or more of the following areas: Credentialing Operations, Network, Corporate Compliance or Quality Management required. Comprehensive knowledge of credentialing procedures, accreditation and regulatory requirements relating to credentialing.
A bachelor's degree in a related field such as business administration or health services administration is preferred
Comprehensive experience with Microsoft Office Suite, excellent organizational, presentation, interpersonal, verbal, and written communication skills. Knowledge of statistical sampling techniques preferred.
- Requires several years of work experience in healthcare compliance, or a related field. Experience with specific regulations, such as those from the Office of Inspector General (OIG), is especially valuable.
- Key skills include strong analytical, investigative, and decision-making abilities, as well as experience reviewing legal and medical information
- Possesses excellent organizational skills and ability to manage demanding workload; initiative-taking; able to fulfill responsibilities with minimum supervision.
- Demonstrated ability to work independently, handling situations that require independent judgment.
- Demonstrated ability to manage specialized electronic database, run reports and analyze data.
- Demonstrated ability to interact with diverse groups of people within the organization and with outside agencies.
- Possesses the analytical skills necessary to follow up information provided on physician and allied health applications.
- Requires ability to pay meticulous attention to detail and to respond to requests for information.
- Adheres to professional confidentiality standards in accordance with legal, ethical, and departmental policies.
- Manages sensitive and confidential situations/information with a high degree of tact and diplomacy.
- Exhibits excellent people skills, including those required for customer service.
Hybrid
Independence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey or Pennsylvania.
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
Inclusion and Belonging
At IBX, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
About Our Company
Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!
Equal Employment Opportunity
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an Independence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.