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Clover Health

Clover Health is a unique health insurance plan focused on driving down costs and producing improved health outcomes.

Provider Credentialing Analyst
United States of America
Job Description / Skills Required

Clover is reinventing health insurance by working to keep people healthier.

Clover Health is a Medicare Advantage and Prescription Drug plan that is changing how healthcare is delivered. The health care delivery system is undergoing many changes, however, most health insurance payers are trying to execute this change with decades old processes and technologies in a top-down framework. 

As a Provider Credentialing Analyst, you will:

  • Review provider, ancillary, and facility credentialing and recredentialing applications and files to ensure completeness of required documentation.
  • Coordinate provider, ancillary, and facility contact to gather missing information.
  • Prepare files to be sent to Credentialing Verification Organization (CVO) for primary source verification.
  • Review files returned from CVO:
    • Clean files
    • Pended files
    • Resolved missing documentation issues by contacting the provider
  • Respond to internal and external resources for credentialing related questions, including the credentialing process, status for specific providers, and claims projects (when credentialing is involved).
  • Act as a point of contact for the Credentialing and Provider Data Management teams for large delegated and directly credentialed groups and outreach for required documentation (attestations and policies and procedures).
  • Research and resolve Salesforce tickets for credentialing related tickets.
  • Assist providers as necessary with problem resolution.
  • Perform other tasks as required.

You will love this job if:

  • You are detail oriented and have exceptional organizational skills with utmost attention to detail and data integrity.
  • You love collaborating with field and operations teams to gather necessary information for Credentialing process.
  • You are a creature of process; understanding the need to optimize and organize data collection, cleansing, sharing, and ingestion.

You should get in touch if:

  • You have previous healthcare experience, especially in credentialing (specifically with NPPES and CAQH) and delegation of credentialing.  
  • You have previous experience managing data sharing with external vendors/holding them to SLAs and SOWs.
  • You have a general understanding of healthcare administration/provider data topics and data elements, such as credential verification, NPI (Type I and II), TIN, and specialty designation.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.

About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.

We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.

From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone's responsibility.