Credentialing Analyst - Health Plan

Are you looking for a career that offers both purpose and the opportunity for growth? Parkland Community Health Plan (PCHP) is a proud member of the Parkland Health family. PCHP is a Medicaid Managed Care Organization servicing Texas Medicaid and CHIP in the Dallas Service Area. PCHP works to fulfill of our mission by empowering members to live healthier lives. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day.

Primary Purpose

Parkland Community Health Plan's (PCHP's) Credentialing Analyst supports the credentialing program that implements federal, state and local regulatory and NCQA accreditation requirements. Ensures that all practitioners and facilities are evaluated upon entry into the PCHP network and conducts an ongoing review of the providers. Gathers, analyzes, and report provider data for the provider directory, billing needs, and member support. Communicates with providers and provider groups to answer their questions and concerns or direct to the proper department. Assists with oversight audits of delegated and non-delegated providers.

Minimum Specifications

Education

• Bachelor's degree is required.

Experience

Equivalent Education and / or Experience

Certification / Registration / Licensure

Skills or Special Abilities

Responsibilities

Job Accountabilities

Parkland Community Health Plan (PCHP) prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.