Billing Credentialing Analyst - EHR

JOB SUMMARYHealthRIGHT 360, a family of programs, operates in 11 counties throughout California. Offering a comprehensive range of medical and behavioral health services, HealthRIGHT 360 serves marginalized communities, including primary care, mental health support, detoxification, residential and outpatient substance use disorder treatment, and transitional services tailored to individuals involved in the criminal justice system.The Electronic Health Records (EHR) department is integral to our operations, ensuring that all electronic health record systems function optimally and that all users receive the necessary training and support. As a fast-paced, service-oriented department, we aim to empower all programs in delivering the best possible client services.The EHR Billing Credentialing Analyst is responsible for coordinating, maintaining, and monitoring provider credentialing and enrollment processes within the electronic health record (EHR) system and associated payer platforms. This position works closely with clinical leadership, Human Resources, Compliance, Billing, and external agencies to ensure providers maintain active and compliant credentials, licenses, certifications, and payer enrollments required for service delivery and reimbursement.This role includes maintaining provider records, tracking credentialing deadlines, supporting onboarding and recredentialing processes, validating provider data accuracy within EHR systems, troubleshooting credentialing-related system issues, and ensuring compliance with county, state, federal, and payer requirements. The EHR Billing Credentialing Analyst will also assist with implementations related to provider setup, workflows, and system integrations associated with credentialing and enrollment processes.

KEY RESPONSIBILITIESCredentialing & Enrollment:

Provider Credentialing Maintenance: Maintain and organize provider credentialing records, licenses, certifications, DEA registrations, NPIs, and payer enrollment documentation within the EHR system.Credentialing & Recredentialing Coordination: Coordinate initial credentialing, recredentialing, and provider enrollment processes with payers, counties, and regulatory agencies.Provider Data Configuration: Configure and maintain provider profiles, specialties, service locations, supervising relationships, and credentialing-related information in the EHR system.Credential Monitoring: Monitor credential expiration dates and ensure timely renewals to maintain provider compliance and uninterrupted billing capabilities.Payer Enrollment Support: Prepare and submit enrollment applications and supporting documentation for provider participation with counties, managed care plans, and other funding entities.Data Validation & Auditing: Conduct regular audits of provider data and credentialing records to ensure accuracy, completeness, and compliance.Issue Resolution: Investigate and resolve credentialing discrepancies, missing documentation, enrollment delays, and provider setup issues.Help Desk Escalation Support: Serve as an escalation resource for credentialing-related EHR support requests and technical issues.Communication & Collaboration: Communicate and collaborate with EHR, Compliance, HR, Billing, Fiscal, and Clinical teams as well as the Counties to ensure provider records remain accurate and compliant.Meetings: Attend and participate in department, inter-team, and agency meetings as appropriate.Miscellaneous: Other duties as assigned.

Process:

Workflow Improvement: Utilize problem-solving skills to improve credentialing workflows, tracking systems, and provider onboarding processes.Implementations: Assist EHR leadership with credentialing-related implementations, provider onboarding workflows, and system enhancements for new programs or funding streams.

Intangibles:

Relationships: Develop and maintain effective working relationships with clinical leadership, HR, compliance teams, and external credentialing entities.Agency Philosophy and Mission: Incorporate agency philosophy and mission in all aspects of job performance.Confidentiality: Maintain confidentiality regarding clients, providers, employees, and operations of the agency in accordance with HIPAA and 42 CFR Part 2.Judgment: Exercise good judgment in the performance of duties and responsibilities.

QUALIFICATIONSEducation, Experience, or CertificationRequired:

Minimum of 3 years' experience working in healthcare credentialing, provider enrollment, EHR systems, or healthcare administrationORMaster's degree or higher.

Desired:

Experience with provider credentialing and payer enrollment processes.Experience maintaining provider data within EHR systems and/or county systems.Experience with compliance tracking, audits, and documentation management.Experience with Help Desk or user support preferred.Knowledge of HIPAA and CFR 42.Familiarity with Medi-Cal, county behavioral health systems, and payer credentialing requirements preferred.