Perform oversight on essential credentialing functions to attain and maintain quality providers in the dental network
Conduct audits for credentialing as well as network data quality
Understand credentialing policies and procedures per NCQA, URAC and CMS standards and other regulatory requirements
Serve as a liaison to delegated entities and vendors to ensure current and adequate credentialing processes are in place
Develop and perform queries for data reporting purposes to include directories, ad hoc reports, and network management reports
Monitor and maintain credentialing and re-credentialing policies and program as well as state and federal requirements to ensure compliance is met
Provide operational and industry knowledge to ensure credentialing practices are followed

Bachelor degree and 2 years of experience in accreditation programs (i.e., NCQA, URAC and CMS programs) or 6 years of experience in accreditation programs
Proficiency in accreditation program standards (ex. NCQA, URAC, CMS)
Knowledge of state and federal requirements for contracting and credentialing
Attention to detail and ability to track information to defined quality standards
Knowledge of documents and their contents used in provider contracting, including applications, agreements, fee schedules, and credentialing
Knowledge of provider contracting terms
Analytical skills
Demonstrated experience understanding and maintaining detailed complex provider records
Attention to detail and ability to enter data and meet defined quality standards
Experience balancing multiple priorities while meeting commitments for quality and delivery at agreed upon schedules
Clear and concise verbal and written communication skills
Proficient in Microsoft Office products, Excel, email and Internet
Ability to work well in a team environment

Network & Credential QA Analyst

Key skills