DescriptionSummary:
Responsible for auditing all complete credentialing applications and to build sound, effective and efficient audit processes.
Responsibilities:
• Coordinate and execute credentialing audits by analyzing provider files for completeness, accuracy, consistency, gaps in employment history, pertinent references, etc.
• Prepare credentialing audit reports and assist in the development of staff training guides, policies, and procedures.
• Manages multiple concurrent audits, plan audits, and related projects while ensuring that all audit tools meet NCQA, TJC, and CMS requirements.
• Responsible for educating and re-educating Associates.
• Maintains strict confidentiality over all information and data.
• Completes as-assigned miscellaneous work-related tasks.
• Consistently meets weekly performance metrics.
• Monitors the Credentialing Coordinators' quality metrics and identifies areas for improvement.
Job Requirements:
- Bachelor's Degree preferred
- High School or equivalent required
- 3 years of experience in medical staff and/or managed care credentialing preferred
- Certified Provider Credentialing Specialist (CPCS) preferred
Work Schedule:
TBD
Work Type:
Full Time
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