Sr Analyst, Provider Data Management(Credentialing)

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference working in everything from scrubs to jeans.

Are we growing? Absolutely and Globally. In 2021 we grew our teams by almost 50% and continue to grow even more in 2022. Are we recognized as a company you are supported by for your career and growth, and a great place to work? Definitely. Evolent Health International (Pune, India) has been certified as “Great Places to Work” in 2021. In 2020 and 2021 Evolent in the U.S. was both named Best Company for Women to Advance list by Parity.org and earned a perfect score on the Human Rights Campaign (HRC) Foundation’s Corporate Equality Index (CEI). This index is the nation's foremost benchmarking survey and report measuring corporate policies and practices related to LGBTQ+ workplace equality.

We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

What You’ll Be Doing:

The Analyst, Credentialing Operations (PDM) will be a dynamic role that will encompass determining provider types who require credentialing, initiating the Primary Source Verification Process (PSV), performing provider outreach, and administrative auditing. This position reports to the Associate Director, Credentialing Operations.

Collaboration Opportunities: 

The Analyst, Credentialing Operations team(PDM) collaborates with the Provider Data Management (PDM) team through our Jira ticking system.

What You Will Be Doing:

• Maintenance of provider data within the credentialing platform
• Ticket intake and triage for internal/externally submitted tickets.
•  Responsible for credentialing and re-credentialing files, including both Type I and Type II files.
•  Maintain working knowledge of and comply with NCQA credentialing and recredentialing guidelines.
• Maintain working knowledge of and comply with partner specific credentialing and recredentialing guidelines, policies, and procedures.
• Ongoing monthly monitoring of exclusions, sanctions, and adverse events
• Represent Credentialing department in meetings and delivering special projects and maintaining concurrent projects as assigned.
• Establishing and maintaining excellent relationships, internally and externally including communication to the leadership team. 
• Maintain contractual service level and/or operational level agreements, as applicable.

Qualifications - Required and Preferred:

• Bachelor’s Degree or equivalent years of work experience-Required.
• Excellent verbal and written communication skills- Required.
• Detail oriented with good organizational skills-Required.
• Ability to work in an agile space and adapt to fluctuating situations-Required.
• Takes initiative and works independently - Required.
• Ability to time manage and reprioritize tasks/projects as appropriate Required.
• Microsoft Office Suite, including Word, Excel, PowerPoint, Outlook-Required.
• Minimum of two to three years’ experience in healthcare field related to credentialing, provider enrollment, provider services, and/or configuration-Preferred.
• General understanding of US health care, Managed Care Organizations, Medicare and/or Medicaid-Preferred.

Mandatory Requirements:

Employees must have a high-speed broadband internet connection with a minimum speed of 50 Mbps and the ability to set up a wired connection to their home network to ensure effective remote work. These requirements may be updated as needed by the business.

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Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.