Credentialing Auditor Job in Irving
Responsible for auditing all complete credentialing applications and to build sound, effective and efficient audit processes.
- 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.
- Bachelor’s degree preferred or equivalent job-related experience
- Minimum of at least (3) years’ experience in medical staff and/or managed care credentialing required
- Certified Provider Credentialing Specialist (CPCS) preferred