Credentialing Auditor (REMOTE)

Job Description

Position Overview: We are seeking a meticulous and detail-oriented individual to join our team as a Credentialing Auditor. The Credentialing Auditor will be responsible for conducting comprehensive audits of credentialing processes to ensure compliance with organizational policies, industry standards, and regulatory requirements. The ideal candidate will possess excellent analytical skills, strong attention to detail, and a deep understanding of credentialing procedures in healthcare or a related field.

Key Responsibilities:

1. Conduct audits of credentialing files and processes to ensure accuracy, completeness, and compliance with organizational policies and regulatory standards.
2. Review credentialing applications, supporting documentation, and verification processes to validate qualifications, licensure, certifications, and other credentials.
3. Identify discrepancies, errors, or inconsistencies in credentialing documentation and processes and collaborate with relevant stakeholders to address and resolve issues.
4. Maintain thorough documentation of audit findings, corrective actions, and follow-up activities to ensure accountability and continuous improvement.
5. Develop and implement audit protocols, checklists, and procedures to streamline credentialing processes and enhance efficiency and effectiveness.
6. Stay abreast of changes in regulations, accreditation standards, and best practices related to credentialing and make recommendations for process improvements as needed.
7. Provide guidance, training, and support to credentialing staff and other stakeholders to promote compliance and adherence to established policies and procedures.
8. Collaborate with internal audit teams, compliance officers, and external auditors to facilitate external audits and ensure compliance with regulatory requirements.

Qualifications:

• Bachelor’s degree in healthcare administration, business administration, or a related field. Master’s degree preferred.
• Minimum of [X] years of experience in credentialing, provider enrollment, healthcare compliance, or a related field.
• Demonstrated knowledge of credentialing standards, regulations, and best practices, such as those set forth by NCQA, URAC, and CMS.
• Strong analytical skills with the ability to review and interpret complex credentialing documentation and data.
• Excellent attention to detail and accuracy with a focus on ensuring compliance and quality assurance.
• Effective communication skills, both written and verbal, with the ability to communicate complex information clearly and concisely.
• Proficiency in using credentialing software, databases, and Microsoft Office applications.

Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification preferred

Earnings

$37.00 hourly

Category

Revenue Cycle