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Summary:

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.

Requirements:

• 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

Work Type:

Full Time

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About CHRISTUS Health

CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.

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https://careers.amcp.org/jobs/18567574/credentialing-auditor