ArchWell Health, LLC
Analyst, Physician Credentialing
ArchWell Health, LLC, Nashville, Tennessee, United States, 37247
Provider Credentialing Analyst
ArchWell Health is a new, innovative healthcare provider devoted to improving the lives of our senior members. We deliver best‑in‑class care at comfortable, accessible neighborhood clinics where seniors can feel at home and become part of a vibrant, wellness‑focused community. Our members experience greater continuity of care, as well as the comfort of knowing they will be treated with respect by people who genuinely care about them, their families, and their communities.
Job Summary: Reporting to the Director of Provider Credentialing, the Provider Credentialing Analyst is responsible for credentialing new providers and maintaining current provider files for our quickly growing medical group. This hire will partner with current credentialing staff and own the end‑to‑end credentialing process, including: submitting and tracking credentialing applications to various contracted managed care plans and government payors for oncoming providers; maintaining the data for all providers within the group; tracking the expiration of certification and licenses; and will act as a liaison between payors, external credentialing service firms, and medical staff, including physicians.
Duties/Responsibilities
Build the ArchWell Health credentialing workplan and processes, including all required credentialing for providers and facilities as dictated by government payors and contracted managed care plans
Complete all necessary credentialing and enrollment workflows for providers and facilities, including, but not limited to:
Data collection and primary source verification
Ensure providers are credentialed in a timely manner by monitoring and maintaining the end‑to‑end submission process for assigned payor contracts
Own all payor reporting, including data reporting and monthly exclusion checks
Oversee ongoing renewals for all required provider licenses and credentials
Assist in building out new payor operations as new contracts are executed
Act as a liaison between government payors and managed care plans, outsourced credentialing services, and ArchWell Health medical staff, including providers
Other projects and tasks as assigned
Required Skills/Abilities
Must understand Medicare, Medicaid, and managed care plan credentialing requirements and must be familiar with CAQH (Council for Affordable Quality Healthcare)
Must also be able to work/communicate with providers in a professional manner to assist in the completion of the CAQH applications
Knowledge of medical terminology, strong organization skills, good written communication skills, ability to work independently, and ability to conduct research while performing job duties
Tech savvy and willing to learn CredentialStream
Must have excellent communication skills to effectively communicate with all levels of staff including internal and external stakeholders
Must be detail oriented
Education and Experience
Location: Remote
Bachelor’s degree preferred
At least three (3) years of medical credentialing and enrollment experience
Proficient PC skills
Embodies and serves as a role model of ArchWell Health’s Values:
Be compassionate
Strive for excellence
Earn trust
Show respect
Stay resilient
Always do the right thing
#J-18808-Ljbffr
Job Summary: Reporting to the Director of Provider Credentialing, the Provider Credentialing Analyst is responsible for credentialing new providers and maintaining current provider files for our quickly growing medical group. This hire will partner with current credentialing staff and own the end‑to‑end credentialing process, including: submitting and tracking credentialing applications to various contracted managed care plans and government payors for oncoming providers; maintaining the data for all providers within the group; tracking the expiration of certification and licenses; and will act as a liaison between payors, external credentialing service firms, and medical staff, including physicians.
Duties/Responsibilities
Build the ArchWell Health credentialing workplan and processes, including all required credentialing for providers and facilities as dictated by government payors and contracted managed care plans
Complete all necessary credentialing and enrollment workflows for providers and facilities, including, but not limited to:
Data collection and primary source verification
Ensure providers are credentialed in a timely manner by monitoring and maintaining the end‑to‑end submission process for assigned payor contracts
Own all payor reporting, including data reporting and monthly exclusion checks
Oversee ongoing renewals for all required provider licenses and credentials
Assist in building out new payor operations as new contracts are executed
Act as a liaison between government payors and managed care plans, outsourced credentialing services, and ArchWell Health medical staff, including providers
Other projects and tasks as assigned
Required Skills/Abilities
Must understand Medicare, Medicaid, and managed care plan credentialing requirements and must be familiar with CAQH (Council for Affordable Quality Healthcare)
Must also be able to work/communicate with providers in a professional manner to assist in the completion of the CAQH applications
Knowledge of medical terminology, strong organization skills, good written communication skills, ability to work independently, and ability to conduct research while performing job duties
Tech savvy and willing to learn CredentialStream
Must have excellent communication skills to effectively communicate with all levels of staff including internal and external stakeholders
Must be detail oriented
Education and Experience
Location: Remote
Bachelor’s degree preferred
At least three (3) years of medical credentialing and enrollment experience
Proficient PC skills
Embodies and serves as a role model of ArchWell Health’s Values:
Be compassionate
Strive for excellence
Earn trust
Show respect
Stay resilient
Always do the right thing
#J-18808-Ljbffr