QA Credentialing Auditor (Telecommuting)
Posted Date: 3/11/2020
The Quality Assurance Credentialing Auditor is responsible for auditing all complete credentialing applications and to build sound, effective and efficient audit processes. We are looking for a highly qualified person who can excel and innovate in this role. The role will combine responsibilities for credentialing providers and process improvements around credentialing. The position will report to the Senior Director of the Centralized Verification Office (CVO) and under the guidance of the Quality Assurance Lead Credentialing Auditor.
- Completes initial and ongoing quality audits of Credentialing Coordinators, while providing constructive feedback and education to individual associates.
- Monitors performance and productivity of all Credentialing Coordinators.
- Audits 100% of credentialing and recredentialing files submitted by Credentialing Coordinators to ensure compliance with relevant accreditation and regulatory standards and internal policies and procedures. The Auditor will also audit the data entered into the Credentialing database.
- Analyze credentialing files for completeness, accuracy, consistency, gaps in work history, relevant references, etc. Identify issues and initiate further data collection as needed.
- Track and trend audit findings and administer appropriate staff education and coaching.
- Manage multiple concurrent audits, plan audits and related projects, make judgments around objectives and scope and ensure effective and efficient execution.
- Review and maintain all audit tools to comply with NCQA, TJC and CMS requirements.
- Conduct pre-delegation audits for applicable areas for existing delegated entities and ensure that vendors continue to perform the delegated activities in accordance with the agreement.
- Coordinates the credentialing and recredentialing process for assigned providers.
- Collects and maintains all pertinent information from the provider. Communicates consistently with providers and provider office staff in a timely and effective manner to obtain required documents in accordance with processing guidelines.
- Verify all credentialing elements, including but not limited to, education, training, board certification, work history, licensure and certifications, malpractice coverage through a variety of primary sources as appropriate per NCQA, TJC & CMS standards.
- Enters data accurately and completely in the credentialing software.
- Assist in the formulation of staff training guides, policies and procedures, understand and interpret policies and regulations.
- All other duties as required and assigned to ensure the CVO operations are successful.
- MUST HAVE MEDICAL STAFF OFFICE EXPERIENCE
- Bachelor's Degree or equivalent work experience.
- 3 to 5 years medical staff management and credentialing experience.
- National Association of Medical Staff Specialists (NAMSS) Certification, CPMSM or CPCS, preferred.
- Excellent communication skills: written and verbal with all internal/external customers.
- Experience with NCQA, TJC and federal and state regulations.
- Strong time management and organizational skills.
- Extensive knowledge of credentialing and re-credentialing practices relevant to accreditation and regulatory standards.
- Abilitiy to handle conflict and difficult situations
- Detail oriented with exceptional accuracy.