at NorthShore University Health System in Skokie, Illinois, United States
Job Description
Payor Credentialing Analyst
Position Highlights:
Position: Payor Credentialing Analyst
Location: Skokie, IL
Full Time
Hours: Monday-Friday, 8am-5pm
Required Travel: N/A
Job Summary:
The Payor Credentialing Analyst position will be managing, investigating, and resolving issues related to data, reporting, and provider database management. Responsibilities include managing data audits and supporting projects that involve data validation, abstraction, and problem resolution. The position also involves executing regular required reporting to external sources, managing data requests, and ensuring the timely and accurate completion of these requests. Knowledge of the provider revenue cycle and claims adjudication is required.
What you will do:
Provide data and reporting from MSOW via Crystal Reports
Builds and fulfills data and report requests for internal requestors (marketing/finance/MSO's etc.) as well as external agencies. External requests are contractually required for health plan agreement, state and regulatory compliance. This is system wide across all hospitals and IPA's.
Provide support for IPA/PHO/CIN partners with commercial health plan issues.
Support partners with enrollment issues with plans. Troubleshoot and resolve correctly per rosters provided and work through claims issues when necessary.
Manages the Endeavor Health Physician Partners credentialing for all IPA/PHO/CIN Entities
Manages providers, plans and IPA specific items accurately for data tracking and reporting. Supports Endeavor Health Physician Partners Credentials Committee and all associated provider related follow up. Completes yearly delegated audits with payors as required contractually and semiannual/quarterly reporting to plans.
Auditing and validating of data across MSOW and interfaces to Epic and Workday
Routine audit of data entry and data validation as needed for system. Troubleshoots and solves issues related to provider records and data. Partners with system colleagues to assure system alignment for provider data management.
What you will need:
Education: Bachelor's Degree required or equivalent experience
Certification: Certified Provider Credentialing Specialist (CPCS) or equivalent experience in hospital and managed care credentialing.
Experience: 3 to 5 years of relevant work experience. This includes experience in data analytics, and project management
Unique or Preferred Skills:
Ability to achieve thoroughness and accuracy when accomplishing a task.
Capability of handling moderately complex database requests with precision.
Strong analytical abilities to investigate and resolve data-related issues.
Proficiency in data validation, abstraction, and problem resolution.
Skilled in implementing and following structured processes to ensure efficiency and consistency.
Excellent customer service skills, with a focus on addressing and resolving client concerns effectively.
Ability to employ a systematic approach to work through details of a situation to reach a solution.
Capability to work efficiently and accurately in a fast-paced, challenging environment.
Proficient in imparting or exchanging information by speaking, writing, or using other mediums.
Ability to orient work and the organization toward serving clients' needs effectively.
Ability to think creatively to introduce new ideas, devices, or methods.
Ability to communicate the importance of acting promptly, decisively, and without delay.
Benefits:
Career Pathways to Promote Professional Growth and Development
Various Medical, Dental, Pet and Vision options
Tuition Reimbursement
Free Parking
Wellness Program Savings Plan
Health Savings Account Options
Retirement Options with Company Match
Paid Time Off and Holiday Pay
Community Involvement Opportunities
Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals - Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) - all recognized as Magnet hospitals for nursing excellence. For more information, visit www.endeavorhealth.org.
When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.
Please explore our website (www.endeavorhealth.org) to better understand how Endeavor Health delivers on its mission to "help... For full info follow application link.
EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.
