Credentialing Quality Analyst

Quality Management Analyst - Credentialing & Legal Appeals

Excel. Empower. Advance. Shine. Belong. Explore. Flourish. Champion.

Make It Happen At Hopkins!

Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institutions in the United States. JHHP is a $2.5B business serving over 400,000 lives with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHP has become a leader in provider-sponsored health plans and is poised for future growth.

The Quality Management Analyst - Credentialing & Legal Appeals is a highly visible role that reports directly to the Credentialing Supervisor. The incumbent is responsible for processing high-risk credentialing files and ensuring accuracy, compliance, and timely completion of all related activities.

Key responsibilities include coordinating meetings with the Chairman of the Special Credentials Review Committee (SCRC), board members, and legal counsel; creating, preparing, and presenting reports to the SCRC; and developing risk assessment packets for review. The role also involves preparing additional reports as needed, scheduling and attending legal meetings and appeal hearings, and creating meeting agendas and minutes.

This position requires the ability to manage a demanding workload while meeting strict deadlines. The ideal candidate will possess exceptional written, verbal, and interpersonal communication skills, with the ability to effectively engage with internal and external stakeholders, including attorneys, medical directors, and healthcare providers.

Strong analytical skills are essential for coordinating information from multiple sources, identifying errors, and detecting subtle inconsistencies in documentation. This role maintains high visibility across the Health System and plays a critical role in supporting credentialing quality and risk management processes.

Requirements

Experience:

Quality Management Analyst I: Requires 3 years of experience in a managed care, business or healthcare environment with proven skills in data analysis, reporting and meeting coordination.

Quality Management Analyst II: Minimum 5 years of experience in a managed care, business or healthcare environment with proven skills in data analysis, reporting and project coordination.

Additional Experience: Requires thorough knowledge of provider credentialing principles, methods, and procedures, typically acquired through a minimum of three (3) years of credentialing experience. Demonstrated experience managing the process of challenging rejected healthcare provider applications in a managed care credentialing environment is required, such as a Credentials Verification Organization (CVO), Managed Care Organization (MCO), Health Maintenance Organization (HMO), or hospital-based credentialing setting (MSO).

Education:

Quality Management Analyst I Associates degree required; Bachelor's degree preferred. Course of study should relate to job function.

Quality Management Analyst II Bachelor's degree in business or health related field or Certified Coder with Associates degree.

Licensure/Certification:

CPMSM (Certified Professional Medical Services Management) or CPCS (Certified Provider Credentialing Specialist) certification preferred but not required.

Salary Range: Minimum 26.51/hour - Maximum 43.76/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.

The Hospital reserves the right to modify employee schedules as needed.

We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.

Johns Hopkins Health System and its affiliates are an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.