Network & Credential QA Analyst
Dearborn Group
full-time
Posted on:
Location Type: Hybrid
Location: Lombard • Illinois • Missouri • United States
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Salary
💰 $38,100 - $80,000 per year
About the role
- Perform oversight on essential credentialing functions to attain and maintain quality providers in the dental network
- Conduct audits for credentialing as well as network data quality
- Understand credentialing policies and procedures per NCQA, URAC and CMS standards and other regulatory requirements
- Serve as a liaison to delegated entities and vendors to ensure current and adequate credentialing processes are in place
- Develop and perform queries for data reporting purposes to include directories, ad hoc reports, and network management reports
- Monitor and maintain credentialing and re-credentialing policies and program as well as state and federal requirements to ensure compliance is met
- Provide operational and industry knowledge to ensure credentialing practices are followed
Requirements
- Bachelor degree and 2 years of experience in accreditation programs (i.e., NCQA, URAC and CMS programs) or 6 years of experience in accreditation programs
- Proficiency in accreditation program standards (ex. NCQA, URAC, CMS)
- Knowledge of state and federal requirements for contracting and credentialing
- Attention to detail and ability to track information to defined quality standards
- Knowledge of documents and their contents used in provider contracting, including applications, agreements, fee schedules, and credentialing
- Knowledge of provider contracting terms
- Analytical skills
- Demonstrated experience understanding and maintaining detailed complex provider records
- Attention to detail and ability to enter data and meet defined quality standards
- Experience balancing multiple priorities while meeting commitments for quality and delivery at agreed upon schedules
- Clear and concise verbal and written communication skills
- Proficient in Microsoft Office products, Excel, email and Internet
- Ability to work well in a team environment
Benefits
- Health and wellness benefits
- 401(k) savings plan
- Pension plan
- Paid time off
- Paid parental leave
- Disability insurance
- Supplemental life insurance
- Employee assistance program
- Paid holidays
- Tuition reimbursement
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
credentialingdata reportingauditingaccreditation programsprovider contractingdata entryquality standardsanalytical skillsnetwork management
Soft Skills
attention to detailcommunication skillsability to track informationability to balance multiple prioritiesteamwork
Certifications
Bachelor degree