Job Description

Job Responsibilities:

• Assists in the preparation of deliverables for the player and internal audit requests
• Assist with credentialing tasks as needed
• Building and maintaining effective, positive internal and external customer relationships
• Conducting ongoing monitoring to evaluate levels of regulatory credentialing and delegated payer compliance with contractual requirements
• Participating in team initiatives and projects and meeting deadlines and quality expectations
• Participate in the development and ongoing implementation of quality improvement activities. Improve quality products and services, by using measurements and analysis to process, evaluate and make recommendations to meet QM compliance objectives
• Performing credentialing business process functions as needed, performing scheduled and random credentialing file audits
• Reviewing risk assessments while participating in ongoing monitoring and annual program evaluation and identification of areas where there can be process improvement

Skills:

• 3+ years of related health care or health plan experience in credentialing compliance, auditing, and quality assurance
• Proficient in Microsoft Office Applications; Excel, Outlook, Word, and Teams
• 2 years’ experience with CAQH requirements and review
• 2 years NCQA standards related to credentialing.
• The ability to create spreadsheets, analyze data and identify trends.
• Strong attention to detail and the ability to multi-task in a fast-paced environment
• 2 years remote work from home experience and the ability to time manage.
• MD-Staff experience is preferred

Education/Experience:

• Bachelor's Degree required

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