Department Analyst focusing on operational resources, data analysis, and managing health plan credentialing for Cleveland Clinic. This role ensures providers meet credentialing requirements with strict deadlines.
Responsibilities
Analyze and evaluate operational and financial functions of administrative and operational units
Analyze departmental resources, services, systems, budgets and programs
Prepare and develop special reports and recommendations based on analysis
Conduct basic statistical analysis and evaluation of unit services and performance
Identify program or service strengths, weaknesses, and financial impact
Identify opportunities for service and program improvement
Assist with the development of operational plans, procedures and systems
Review and evaluate current procedures and systems and develop recommendations for improvement
Maintain awareness of and comply with various regulatory guidelines (JCAHO, FDA, HIPAA, OSHA, etc.)
Manage credentialing for CCF providers across multiple commercial health plans
Ensure compliance with health plan credentialing criteria and delegated credentialing standards
Perform primary source verification for licensure and credentials
Maintain and update large provider rosters in Excel
Meet tight deadlines (36–48 hours post-committee approval) for releasing providers to health plans
Coordinate with internal teams to ensure accurate and timely credentialing
Requirements
Bachelor’s Degree in Business, Healthcare Administration or a related field and one year of statistical analysis experience or five years of relevant experience in a health care setting
High School Diploma/GED and five years of experience OR Associate's Degree and three years of experience OR Master's Degree
Two years of commercial health plan credentialing experience OR medical staff office credentialing experience
Excel proficiency: (filtering, sorting, find/replace, navigating large rosters)
Understanding of credentialing criteria for health plans
Knowledge of delegated credentialing vs. manual enrollment
Knowledge of primary source verification processes
Comfortable working in a fast-paced environment with large data sets
Experience with credentialing processes and compliance standards
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