Overview

The RCS Credentialing Analyst exists to support physicians, advanced practice providers and allied health practitioners throughout the IU Health recredentialing, reappointment and outside facility reappointment processes. The team member will serve as the expert and primary point of contact for providers and leaders across the entire enterprise in order to facilitate recredentialing to keep our providers compliant with NCQA and delegated credentialing payer agreements. This position will inspire a culture of excellence for existing providers. Essential Functions Credentialing Analyst Process Oversight: Serves as the provider recredentialing expert and primary point of contact across the organization. Provides coordination between the practitioner and key stakeholders representing executive leadership, administration, hospital medical staff offices, and provider enrollment. Manages resources, data collection, and project management tools which enhance the recredentialing and reappointment efforts. Coordinates onboarding activities for practitioners to include but not limited to, making sure CAQH and attestations (Council for Affordable Quality Healthcare database) are up to date for recredentialing so payers can access the providers information and keep them enrolled per our delegation agreements. Ensures all credentialing data is up to date and accurate such as board certification, license, state CSR (Controlled Substance Registration), DEA (Drug Enforcement Administration), malpractice insurance, NPDB (National Practitioner Databank), IPCF (IN Patient’s Compensation Fund), OIG (Office of Inspector General), SAM (System for Award Management), Medicare Opt Out, and NPI (National Provider Identifier). Notifies CVO of any out-of-date verifications or data for correction before presenting the file for audit and to the Credentials Committee. Assists the MSO with getting reappointment applications received from providers timely by involving SLAs, Practice Administrators, and other stakeholders. Assists providers with outside facility reappointment processes. Also, contributes by processing additional facility requests within IU Health, Inc. system for hospital privileges at IU Health Hospitals. Runs accurate and timely reports reflecting the current recredentialing status and identifying any issues or obstacles which could potentially delay the process and escalates as appropriate. Instructs and notifies various stakeholders in the process to ensure timely recredentialing for IUHP Credentials Committee and for hospital reappointment processes. Develops and administers education materials to continuously improve service quality and reduce recredentialing cycle time. Provides ongoing support by responding to the needs and concerns of all existing providers. Helps providers stay compliant with CME, CEU and RQI by notifying the provider and SLA of upcoming requirements. Credentialing / Privileging: Follows established protocols and procedures for requesting and collecting all recredenitaling documentation. Ensures accurate information is entered, maintained, and made available to stakeholders via the credentialing centralized credentialing database. Assists in obtaining pertinent information and primary source verifications required to successfully complete recredentialing and reappointment/privileging processes. Develops and maintains a high degree of knowledge regarding current credentialing / privileging procedures and regulatory compliance requirements. Prepares all files for review by the IUHP Credentials Committee according to established policies and procedures to ensure high quality files and adherence with NCQA and payer requirements. Communication / Partnering: Communicates information regarding the recredentialing status with the practitioner, service line leaders, and other authorized parties. Interfaces routinely with both internal and external staff to acquire information and documentation requested by key stakeholders. Provides friendly, transparent customer service while maintaining a high level of confidentiality of personal and sensitive data at all times. Customer Service Accountabilities: Partners with Service Line Administrators / Practice Administrators to execute efficient provider recredenitaling. Establishes collegial relationships with internal and external staff to ensure timely recredentialing which will ensure the successful continuation of credentialing, enrollment, and privileging within IU Health and outside hospitals. Meets expectations of preeminent service, including behavior that models Service Excellence and demonstrates the four Service commitments of the organization (Team, Excellence, Compassion and Purpose). Demonstrates respect consistently by responding to the requests of others in a polite, friendly, informative, and timely manner. Assumes ownership of customer problems and ensures all issues are addressed, resolved, or referred to the appropriate person. Confidentiality: Maintains the confidentiality of any patient or employee medical, financial, or personal information and other information, records, and data to which there is access at all times. Views, uses, or discloses such information only for reasons necessary to perform duties. The preceding essential function statements are not intended to be an exhaustive list of tasks and functions for this position. Job descriptions provide a representative summary of the major duties and responsibilities performed by incumbents. Other tasks and functions may be assigned as needed to fulfill the mission of the organization. Job Family: ( Administrative/Clerical/Office ) Job Family || Job Behavior ________________________________________ QUALIFICATIONS/KNOWLEDGE/SKILLS/ABILITIES: Bachelor’s Degree with emphasis in Business, Human Resources, or Healthcare Related field is preferred. 3-5 years of experience in credentialing, healthcare, human resources, recruiting, or equivalent combination of education and experience may be accepted in lieu of degree. Knowledge of regulatory requirements and guidelines surrounding credentialing and privileging processes preferred including NCQA Accreditation standards, CMS, and Joint Commission Privileging Standards. Requires ability to prioritize and manage multiple competing projects while working independently without constant supervision. Requires ability to manage project timelines and work under pressure of deadlines with frequent interruptions. Requires ability to communicate clearly and concisely, both verbally and in writing, including public presentation skills. Requires ability to communicate effectively across all levels of the organization and with diverse customers. Requires ability to collaborate successfully with multiple stakeholders and exercise sound judgement. Requires ability to analyze problems and develop effective techniques for resolution. Requires ability to anticipate problems and initiate corrective action. Requires ability to handle sensitive information and situations with confidentiality and tact. Requires ability to create and foster relationships. Requires strong attention to detail and organizational skills. Requires proficiency in Microsoft Office products including Access, Excel, Outlook, and Word, Power BI, data entry in Sequel database and knowledge of CAQH.

Qualifications for the RCS Credentialing Analyst Role

Indiana University Health is Indiana’s most comprehensive health system, with 16 hospitals and more than 34,000 team members serving Hoosiers across the state. Our partnership with the Indiana University School of Medicine gives our team members access to the very latest science and the very best training, advancing care for all. We’re looking for team members who share the things that matter most to us. People who are inspired by challenging and meaningful work for the good of every patient. People who are compassionate and serve with a purpose. People who aspire to excellence every day. People who are always ready to apply themselves.