works with team members to ensure annual audits, pre-assessments, provider rosters, file reviews, and reports are accurate, complete, and meet client deliverable deadlines
maintains delegated credentialing internal tracking tools to monitor performance
provides compliance oversight for client reporting requirements and client corrective action plans
collaborates with team members to respond to, investigate, and resolve issues identified in client corrective action plans, monitors, and documents progress
acts as departmental liaison to client executives and health plan clients on order to support delegated credentialing activities
provides timely response to health plan client and/or corporate audit requests, monitors, and documents progress
assists in creating and updating delegated credentialing policies and procedures as directed to ensure compliance with ncqa and other applicable federal/state regulatory requirements
summarizes and analyzes department key performance indicators and prepares weekly status report and reviews with team members
monitors and tracks health plan client data and reporting requests
collaborates with the provider credentialing team to review the accuracy and completeness of provider rosters/provider files and delivers to health plan clients
identifies opportunities for process improvement
performs reviews and quality controls of ncqa credentialing accreditation documentation, ensuring secure file exchanges, credential file preparation, etc.
works with business owner and subject matter experts to update documentation as needed for the joint commission accreditation surveys
supports ncqa file audits to assess the quality of provider files. reports findings to the manager of credentialing and data reporting for use in staff trainings
performs other duties as assigned
partners with the network credentialing reporting team to ensure the thoroughness and accuracy of all client deliverables including corrective action plans and corporate-wide audit
required qualifications:
3 years of managed care and/or credentialing experience
proficiency and strong experience in analyzing payer contracts and other legal documents pc proficiency, proficiency in microsoft office applications and ability to effectively utilize other software and systems as needed
strong written and verbal communications skills
impeccable attention to detail
knowledge of regulatory/accreditation requirements and standards including ncqa, urac, cms and the joint commission
understanding of government program provider enrollment, credentialing regulations and requirements
ability to establish and maintain positive relationships, building trust and respect by consistently meeting expectations
we only need 1 person for this position - so all qualified candidates need to apply now!
equal opportunity employer/veterans/disabled
the company will consider qualified applicants with arrest and conviction records
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United States, Woonsocket ,Rhode Island
2022-04-25
2022-05-25
1328069
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