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Credentialing Business Analyst

Job ID: 168491
Category: Other
Work Type: FT
Location: Philadelphia, PA, United States
Date Posted: Jan 18, 2023
Work Schedule: Full Time

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Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Credentialing Business Analyst

Corporate Services, Medical Affairs - Admin

3600 Civic Center Blvd.

Summary:

The Credentialing Business Analyst is accountable for continual monitoring, improvement and maintenance of the Central Verification Organization's paperless credentialing system and process in order to ensure the timely and accurate credentialing of the CVO's 9,000 + providers in accordance with appropriate regulatory approvals. This position will collaborate with various levels of Office of Medical Affairs staff and departments across the health system to provide analysis and technical assistance.

Primary responsibilities will include:

  • Trending and identifying issues related to the credentials process and timeliness of processing applications for physicians and other health care practitioners applying to Penn Medicine or appointment, reappointment and/or clinical privileges in accordance Penn Medicine Central Verification Organization (CVO) Policies and Procedures and applicable hospital bylaws, Pennsylvania Department of Health, The Joint Commission (TJC), and the National Commission Quality Assurance (NCQA) standards.
  • Preparation for and participation in NCQA and payer CVO surveys.
  • Management of the Provider Enrollment Approval Committee (PEAC) process.
  • Working directly with OMA Director, Credentialing Sr. Manager and MSO Supervisor, in coordination and support of projects.
  • Interpretation of data, identification of modification requirements and recommendations.
  • Support and feedback regarding projects.
  • Monitoring of automated ECHO processes and escalating issues to support team and/or vendor.

Accountabilities:

  • Report Writing, Analysis & Documentation:
  • Lead and document root cause analysis of provider maintainence reports and enrollment payment discrepancies with viable recommendations.
  • Quarterly summary and detail reports as assigned to senior leadership and Medical Staff Offices (MSO).
  • Create and maintain documentation and updates related to the core credentials and privileging process.
  • Create standard and ad-hoc reports in Echo through development and maintenance of filters and reports and by using raw data supplied by the Development Team, including but not limited to reports on credentialing performance.
  • Investigate discrepancies related to applications, privileging and supporting documentation; formulate appropriate course of action; examine for compliance with Penn Medicine staff qualifications and criteria.
  • Identify and flag time-sensitive credentialing information for reporting and escalation.
  • Surveys:
  • Prepare for and conduct CVO payer audit/surveys as assigned.
  • Assist in the preparation for and conduct of biannual NCQA CVO surveys.
  • Payer Credentialing.
  • System Development & Troubleshooting:
  • Collaborate with staff and IT developers including Jira (project management software) stories (end-user requirements) and assess requirements for the development of a credentialing system initiative or enhancement; Assist in the prioritization of stories with the Development Team.
  • Participate in integrated system testing related to the credentialing process.

Licenses, Registrations, Certifications:

  • NAMSS CPCS required (or within one year).
  • Project Management preferred.

Education or Equivalent Experience:

  • H.S. Diploma/GED and 4+ years of proven experience in project management credentialing, payor enrollment, hospital, or similar experience required.
  • OR Bachelor's Degree (Business Administration, Health Care, Computer Science preferred) and 2+ years proven project management experience in credentialing in a managed care, hospital or related setting required.
  • Proven experience and proficiency as CVO Analyst or equivalent required.
  • Master's Degree Business Administration, Health Care, Computer Science and 2+ years proven project management experience preferred.
  • Extensive knowledge of all credentialing processes, systems, and interfaces (e.g. ECHO, P4P, Origami, PennMAPP, etc.) preferred.

Skills and Abilities:

  • Complete Understanding of all applicable regulatory standards, all Penn Medicine medical staff bylaws and applicable policies, and business rules.
  • Excellent time management and organizational skills with the ability to handle competing priorities.
  • Demonstrated ability to work independently and cross functionally.
  • Ability to effectively interact with customers to understand their needs, explain data, requirements and provide recommendations.
  • Demonstrated ability to maintain information in a confidential manner in accordance with all regulatory requirements, HIPAA and PHI.
  • Self-motivated, detailed oriented, quality and precision focused.
  • Excellent problem solving, critical thinking and analytical skills. Demonstrate good judgement, professionalism and discretion.
  • Proficient in computers and computer software including, but not limited to, database management, etc. Spreadsheet and word processing applications. Advanced training in database management preferred.

    We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

    Live Your Life's Work

    We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

       Current UPHS employees must apply HERE
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