Quality Management Credentialing Analyst

A large healthcare insurance company is looking to hire a Quality Management Credentialing Analyst to their Final Optical Check Quality Management team. This person will work alongside the credentialing team and Board Committee to develop and update policies, audit and review processes, and assist in building out a strong provider base in both the physical and behavioral health field. Responsibilities include developing, implementing, and facilitating the regulatory and accreditation credentialing investigation process. They will Identify and analyze the credentialing processes for high-risk, high-volume and problem prone credentialing processes to mitigate risk and improve provider satisfaction. This person will use their previous credentialing background to recommend a plan of corrective action for resolution and follows up for adverse trends identified via data analysis. They will follow NCQA accreditation, CMS state and federal laws/regulations as well as internal policies

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com .

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Required Skills & Experience
- 3-5 years of experience in credentialing, supporting either a Medical Staff Office or Provider Enrollment team
- Working experience/Knowledge of NCQA and CMS standard
- HS Diploma

Nice to Have Skills & Experience

Bachelors Degree
Clinical License

Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.