Credentialing Specialist

hace 1 semana


Caimito Barrio, Puerto Rico Alameda Alliance A tiempo completo

Job Summary

The Credentialing Quality Assurance Specialist will be responsible for auditing the quality of work performed by Credentialing staff to ensure it meets the requirements of Alameda Alliance's regulatory agencies and guidelines. This includes reviewing credentialing database accuracy, performing provider file audits, and working with the Senior Manager, Peer Review and Credentialing to complete annual audits and maintain reports.

Key Responsibilities

  • Audit credentialing database accuracy and perform provider file audits
  • Work with the Senior Manager, Peer Review and Credentialing to complete annual audits and maintain reports
  • Review and update license monitoring reports received from the Credentials Verification Organization
  • Process initial and re-credentialing application requests, evaluate applications for completeness, and track and follow up on all credentialing and re-credentialing documentation
  • Provide administrative support for the Peer Review Committee and Credentialing Committee meetings

Requirements

  • Bachelor's degree in a health-related discipline or equivalent experience
  • 1-3 years of experience within a health care/managed care environment
  • National Association Medical Staff Services (NAMSS) Certified Provider Credentialing Specialist (CPCS) and/or Certified Professional Medical Staff Management (CPMSM) certification preferred
  • Working knowledge of Medical Staff principles and operations specific to regulatory expectations

About Alameda Alliance

Alameda Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or local laws.



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