Responsible for auditing all complete credentialing applications and to build sound, effective and efficient audit processes.
Responsibilities:
Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
Coordinate and conduct credentialing audits analyzing provider files for completeness, accuracy, consistency, gaps in work history, relevant references, etc.
Prepare credentialing audit reports tracking and trending auditor findings and assist in the formulation of staff training guides, policies and procedures Manages multiple concurrent audits, plan audits and related projects ensuring all audit tools comply with NCQA, TJC and CMS requirements Coordinates the credentialing and re-credentialing process for assigned providers
Requirements:
Bachelor's Degree preferred
High School or equivalent required
3 years of experience in medical staff and/or managed care credentialing preferred
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