Credentialing Analyst

PN Clinical Support Services
Full Time
Day Shift
8a-5p, Mon-Fri

Consistently named best hospital, Lexington Medical Center anchors an expansive health care network that includes nearly 600 physicians and advanced practice providers at nearly 80 locations across the Midlands of South Carolina, making it the region’s third largest employer. From general medicine and orthopaedics to oncology, cardiology and neurosurgery, these dedicated professionals combine the highest quality care with advanced medicine and state-of-the-art technology to help patients achieve the best possible outcomes.  Its postgraduate medical education programs include family medicine and transitional year residencies.

Job Summary

Administer all functions related to the enrollment and re-credentialing of providers and groups with governmental and commercial payers.

Minimum Qualifications

Minimum Education: High School Diploma or Equivalent
Minimum Years of Experience: 3 Years of managed care experience in positions that involved or provided exposure to the credentialing process.
Substitutable Education & Experience: 3 Years of experience can be substituted for one of the following:
Bachelor's Degree;
Associates Degree with 1 year of managed care experience in positions that involved or provided exposure to the credentialing process.
Required Certifications/Licensure: None.
Required Training: Experience in database, spreadsheet and word processing applications;
Experience with problem solving techniques;
Basic understanding of revenue cycle;
Working knowledge of managed care terminology and reimbursement methodologies;
Working knowledge of NCQA credentialing criteria.

Essential Functions

  • Develops and implements systems and procedures to ensure all credentialing processes are completed in accordance to relevant regulation, policies and standards.
  • Investigates, analyzes and/or corrects any third payer issues including and not limited to appropriate  provider and/or group set-up errors.
  • Develop, analyze and trend reports as related to Credentialing processes. 
  • Facilitates and coordinates third party payer audits for delegated credentialing.
  • Work with Accounting to ensure EFT applications are completed where applicable to provider/group enrollment.
  • Knowledgeable of credentialing trends across industry through publications, attending state seminars, educational workshops and conferences.
  • Initiates and coordinates the acquisition and receipt of all credentialing documents from new and existing providers and groups.
  • Utilizes all available resources (on-line websites, software) to aid in the background checks and license verifications of all provider applications.

Duties & Responsibilities

  • Coordinates the processing, distribution and management of all credentialing and accreditation documents for affected providers to applicable health plans.
  • Communicates with all applicable internal areas on status and completion of credentialing with applicable payers.
  • Maintains a comprehensive credentialing database, ensuring data integrity of provider information.
  • Administers and coordinates provider licensing, ensuring receipt within regulation parameters and payer requirements.
  • Develops and maintains strong relationship with team members and outside agencies to ensure harmonious relationships.
  • Communicates requested information to payers in a timely and professional manner.
  • Maintains and ensures strict confidentiality of files and databases.
  • Performs all other duties as assigned.

We are committed to offering quality, cost-effective benefits choices for our employees and their families:

  • Day ONE medical, dental and life insurance benefits 
  • Health care and dependent care flexible spending accounts (FSAs)
  • Employees are eligible for enrollment into the 403(b) match plan day one.  LHI matches dollar for dollar up to 6%.
  • Employer paid life insurance – equal to 1x salary
  • Employee may elect supplemental life insurance with low cost premiums up to 3x salary 
  • Adoption assistance
  • LHI provides its full-time employees employer paid short-term disability and long-term disability coverage after 90 days of eligible employment
  • Tuition reimbursement
  • Student loan forgiveness

Equal Opportunity Employer
It is the policy of LMC to provide equal opportunity of employment for all individuals, and to remain compliant with applicable state and federal laws and regulations. LMC strives to provide a discrimination-free environment, and to recruit, select, on-board, and employ all employees without regard to race, color, religion, sex, age, disability, national origin, veteran status, or pregnancy, childbirth, or related medical conditions, including but not limited to, lactation. LMC endeavors to upgrade and promote employees from within the hospital where possible and consistent with the employee’s desires and abilities and the hospital’s needs.

Nearest Major Market: Columbia
Nearest Secondary Market: South Carolina