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Adaptive Solutions Group
http://www.adaptivesg.com
http://www.adaptivesg.com
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Credentialing Business Analyst
1 Pershing Square , 2301 Main Street Kansas City, MO 64108 US | Fully Remote TELECOMMUTE US
Posted: 10/01/2024
2024-10-01
2024-11-03
Employment Type:
Contract
Job Category: Business Analyst/ Product Manager
Job Number: 16762
Job Description
Adaptive Solutions Group is a premier provider of information technology personnel. We provide a variety of technical professionals available for contract, contract-to-hire, or direct placement positions to companies in and around the Kansas City and St. Louis areas.
We are currently looking for a Credentialing Business Analyst to join our team.
Responsibilities
Required Qualifications
Preferred Qualifications
Adaptive Solutions Group offers a competitive compensation and benefits package that includes medical, dental, STD/LTD, life insurance coverage, 401k, paid vacation and holidays.
Adaptive Solutions Group is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.
We are currently looking for a Credentialing Business Analyst to join our team.
Responsibilities
- Analyze, document, and optimize the end-to-end credentialing process for healthcare providers.
- Ensure timely and accurate completion of credentialing and re-credentialing processes in line with industry standards (e.g., NCQA, URAC).
- Monitor provider data quality and ensure compliance with regulatory and organizational standards.
- Gather and document business requirements from key stakeholders (e.g., provider relations, compliance, IT).
- Develop process flow diagrams, use cases, and business process documentation.
- Collaborate with IT teams to implement and enhance credentialing software solutions (e.g., CAQH, MD-Staff).
- Perform data analysis to identify gaps or inefficiencies in the credentialing process.
- Create and maintain dashboards and reports to monitor key performance indicators (KPIs) and compliance metrics.
- Ensure data integrity and accuracy across credentialing databases and systems.
- Work with cross-functional teams including provider networks, compliance, operations, and IT.
- Liaise with providers, payers, and accreditation bodies to resolve credentialing issues and ensure compliance.
- Provide training and support to staff on credentialing processes and systems.
- Stay updated on industry regulations and accreditation standards (e.g., NCQA, CMS).
- Conduct internal audits of credentialing files to ensure compliance.
- Develop and implement corrective action plans for areas of non-compliance.
Required Qualifications
- Bachelor’s degree in Business Administration, Healthcare Management, or a related field.
- 3-5 years of experience in credentialing, healthcare operations, or business analysis.
- Strong understanding of healthcare credentialing processes, standards, and regulatory requirements (e.g., NCQA, URAC).
- Proficiency in credentialing software platforms (e.g., CAQH, MD-Staff).
- Excellent analytical, problem-solving, and communication skills.
- Experience with data analysis, reporting tools, and process improvement methodologies (e.g., Six Sigma, Lean).
- Ability to work collaboratively with cross-functional teams and manage multiple priorities.
Preferred Qualifications
- Experience in the payer-provider space or healthcare insurance.
- Certification in business analysis (e.g., CBAP, PMI-PBA)
- Familiarity with SQL or other data querying languages.
Adaptive Solutions Group offers a competitive compensation and benefits package that includes medical, dental, STD/LTD, life insurance coverage, 401k, paid vacation and holidays.
Adaptive Solutions Group is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.
Job Requirements
credential, healthcare, accreditation, SQL, CAQH, privileging, FACETS, validation,
data analysis, reporting,
data analysis, reporting,
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