Compliance Analyst - Credentialing

Location: Atlantic City, NJ  |  Position Status: Full Time  |  Position Shift: Days
Provides key support and analyses to the provider enrollment credentialing process that directly impact the ability of AtlantiCare to bill for services rendered by billable providers, thereby directly impacting AtlantiCare revenue generation for providers. The framework for provider enrollment credentialing includes compliance in an increasingly complex regulatory environment defined by The Joint Commission, Department of Health, National Committee for Quality Assurance and Centers for Medicare & Medicaid standards.

The compliance analyst will audit 100% of credentialing and reappointment (re-credentialing) files submitted by credentialing specialists to ensure compliance with National Committee for Quality Assurance (NCQA), The Joint Commission (TJC) accreditation and other regulatory standards, internal policies and procedures, and managed care plan requirements. The analyst will also audit data entered in the credentialing database for completeness, accuracy, consistency, gaps, etc. This position will perform all necessary follow-up activities related to audit errors to ensure that corrections have been made appropriately and will serve as subject matter expert and coach for the credentialing specialists.   

This position supports organizational goals by providing quality customer service, participating in performance improvement efforts and demonstrating a commitment to teamwork and cooperation.

  • EDUCATION: Bachelor's degree preferred.
  • EXPERIENCE: 5 years in healthcare or NCQA, managed care environment and/or related experience. Experience with computer spreadsheets and databases, as well as audit software literacy. Analytical skills and ability to define problems, collect data, establish facts and draw valid conclusions. Strong written and verbal communication. Proficiency in application of audit theory, standards, procedures and techniques. Ability to interpret and apply department policies and procedures.
AtlantiCare is an equal opportunity employer that takes affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disability.
Amanda Pastore
Talent Acquisition Partner
Applicants only. We are not accepting inquiries or solicitations from recruiters/search firms.

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Live the beach-life balance you’ve always wanted

Whether you lead an active life or love leisure, you’ll enjoy working and living in the beach communities of New Jersey’s southeastern shore.

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Benefits & Wellness

We believe that healthcare should be a rewarding career. That’s why we offer excellent compensation, exceptional health and wellness benefits, and internal resources and programs to support professional growth for our team members. Here, you’ll find everything you need to pursue your calling of caring for others, knowing that you’re working for an organization dedicated to your overall well-being.

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Diversity and inclusion are at the heart of what makes AtlantiCare a great organization. We recognize and celebrate individual differences as dimensions that enrich our workforce and allow us to be more creative, flexible and competitive. Our inclusive culture welcomes our employees to freely contribute their diverse ideas, background, talents and experiences to make this a place where everyone can be, and do, their best work together.

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For many, the shore communities of southeastern New Jersey are vacation destinations, but for AtlantiCare employees, they’re home. Working at AtlantiCare allows you to experience shore life year-round. Here, you’ll find natural beauty, world-class entertainment, rich history, amazing arts, abundant outdoor recreation, shopping, sophisticated dining and plenty of family-friendly events all within communities you’ll love to call home.

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