Centria Healthcare

  • Credentialing and Authorization Analyst

    Job Locations US-MI-Farmington Hills
    Area Of Interest
    Accounting/Finance
  • Overview

    The Credentialing and Authorization Analyst is responsible for conducting internal audits, tracking and
    analyzing monthly reports, and assisting with daily credentialing/re-credentialing activities as deemed
    necessary by the EVP of Revenue Cycle.

    Responsibilities

    • Coordinate and conduct pre-delegation and credentialing audits, prepare audit reports, and follow-up and respond to corrective action plan (CAP) for the audits, as applicable.
    • Track, follow-up, analyze and report on monthly credentialing activities, errors and opportunities
    • Assist Credentialing Manager with reports, as required.
    • Actively participate in monthly meetings, credentialing activities and updates.
    • Prepare and present credentialing activities and files for oversight audits, as required.
    • Assist with general credentialing/re-credentialing activities as deemed necessary by the EVP of Revenue Cycle.
    • Other duties as assigned

     

    Qualifications

    • A minimum of 1-2 years of prior credentialing audit experience, preferably in a managed care setting.
    • Knowledgeable of current Joint Commission, CMS, DHCS, DMHC and other regulatory body’s credentialing standards
    • Thorough experience in health care, legal services, privacy or investigative services.
    • Strong analytical and problem-solving skills.
    • A Bachelor’s degree or the equivalent combination of education and experience is required.
    • Typically, requires advanced knowledge of job area typically obtained through advanced education combined with experience. May have practical knowledge of project management.
    • Expertise in Microsoft Office (Word, Excel, and Access)
    • Excellent written and verbal communication skills
    • Ability to multi-task and complete in a timely manner
    • Excellent organizational and time-management skills
    • Detail oriented

    All applicants receive consideration of employment without regard to race, color, creed, religion, age, sex, national origin, ancestry, disability, veteran status, size, height, weight, marital status, family status, gender identity or expression, affectional or sexual orientation, genetic information, or any other legally protected status

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