Credentialing Analyst

Job not on LinkedIn

🕒 September 24

🏄 California – Remote

🏄 California – Remote

💵 $38 - $41 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 4%

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Advanced Medical Management

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 1995

🏥 Healthcare

💼 Consulting

🤝 B2B

Healthcare • Consulting • B2B

Advanced Medical Management is a full-service management services organization (MSO) founded in 1995 that provides healthcare business management and consulting services to physician groups, independent practice associations (IPAs), and payer clients. AMM operates as an IPA management company and fiscal intermediary, administrating and servicing a variety of commercial and government agency clients while offering strategic planning, project development, and health system development support. The firm emphasizes nurturing physician relationships with openness and trust and has experience handling thousands of managed-care lives for IPA clients throughout California.

📋 Description

• Perform initial credentialing and recredentialing in accordance with NCQA standards, health plan requirements, and company policies • Conduct primary source verification of licensure, DEA, board certification, education and training, work history, malpractice history, and sanctions/exclusions • Assemble provider profile intake documentation and enrollment applications for payer submission • Provide one-on-one provider support sessions • Prepare audit-ready credentialing files for Credentialing Committee review • Track files through approval, submission, and directory listing • Collect and verify malpractice insurance certificates and tail coverage documentation • Manage expirable licenses, DEA registrations, board certifications, and certificates of insurance with proactive renewal outreach • Coordinate CAQH profile setup, maintenance, and attestations • Maintain separation-of-duties and conflict-of-interest safeguards • Prepare, submit, and track state medical license applications and renewals • Manage DEA and state controlled-substance registrations, including fingerprinting and licensing-board correspondence • Guide newly employed physicians through licensing and credentialing prerequisites • Support timely processing of provider credentialing and payer enrollment • Reconcile payer rosters against internal provider data and employment/sub-contractor status • Perform quarterly operations reconciliation of provider rosters, enrollment status, and directory listings • Maintain the provider onboarding and credentialing status tracker • Report status, aging, and blockers to leadership • Review intake packets for completeness before submission • Track and report data and updates in applicable software/databases • Support delegated credentialing audits and health plan or regulatory audit preparation • Assist with payer and provider inquiries and perform department projects

🎯 Requirements

• 3+ years of provider credentialing experience with a medical group, IPA, MSO, CVO, or health plan • Working knowledge of NCQA credentialing standards and primary source verification requirements • Hands-on experience with state medical board licensing and DEA registration processes • Proficiency with CAQH ProView, NPPES, PECOS, and credentialing databases/software • Strong Microsoft 365 and Excel skills • Ability to independently manage a high-volume pipeline with accuracy and follow-through in a remote setting • High school diploma or equivalent • CPCS or CPMSM certification (NAMSS) preferred • Multi-state licensing experience preferred; Washington, Hawaii, New York, New Jersey, or Georgia a plus • Experience in a delegated credentialing environment preferred • Experience supporting physicians transitioning from hospital employment to group practice preferred • Associate or bachelor's degree preferred • Bilingual (Korean or Spanish) a plus

🏖️ Benefits

• Full employer-paid HMO • Option for a flexible PPO plan • Discounted vision and dental premiums • FSAs for healthcare and dependent care costs • 401(k) • Generous PTO • 40 hours of sick pay • Paid holidays • Tuition reimbursement • Paid company outings and lunches

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