Credentialing Auditor-Staff Credentialing

Summary:

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.

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 Type:

Full Time