Credentialing Quality Assurance Auditor

We're seeking a Quality Assurance Auditor to join our team! Under the direction of the Quality Assurance Manager and in collaboration with the Credentials Verification Office (CVO) and Physician Hospital Organization (PHO)/Medimore, the Quality Assurance Auditor performs audits of credentialing files completed by both the CVO and PHO. Communicates audit results to the relevant team for follow up and correction. Adheres to the highest standards of credentialing review to ensure compliance with all legal, regulatory, and accreditation requirements, as well as best practice credentialing tasks identified by UnityPoint Health.

This position is open to remote/work from home with strong preference for candidates residing within the UPH geographies of Iowa, Illinois, & Wisconsin.

COVID-19 and Flu Vaccination Requirement: It is required to be fully vaccinated for COVID-19 and Influenza. Exemption requests based on medical or religious reasons may be submitted, but must be approved for active employment.

Why UnityPoint Health?

• Commitment to our Team – We’ve been named a  Top 150 Place to Work in Healthcare 2022  by Becker’s Healthcare for our commitment to our team members.
• Culture – At UnityPoint Health, you matter. Come for a fulfilling career and experience  a culture  guided by uncompromising values and unwavering belief in doing what's right for the people we serve.
• Benefits – Our competitive  Total Rewards  program offers benefits options that align with your needs and priorities, no matter what life stage you’re in.
• Diversity, Equity and Inclusion Commitment – We’re committed to ensuring you have a voice that is heard regardless of role, race, gender, religion, or sexual orientation.
• Development – We believe equipping you with support and  development opportunities  is an essential part of delivering a remarkable employment experience.
• Community Involvement – Be an essential part of our core purpose—to improve the health of the people and communities we serve.

Visit us at UnityPoint.org/careers to hear more from our team members about why UnityPoint Health is a great place to work.  https://dayinthelife.unitypoint.org/ 

Responsibilites:

• Responsible for auditing complete credentialing applications and building sound, effective and efficient audit process.
• Completes initial and ongoing quality audits for credentialing while providing constructive feedback and education to peers and assigned teams
• Perform audit reviews in a timely, efficient, and accurate manner to ensure compliance with relevant accreditation and regulatory standards and internal policies and procedures.
• Utilize basic audit skills and practices to identify, document, test the effectiveness of internal processes and controls and develop sound conclusions.
• Review, utilize auditing tools and critical thinking skills to identify gaps and/or errors in credentialing files ensuring it applies to NCQA, TJC, DNV, CMS, Federal, State and all other requirements.
• Analyze credentialing files for completeness, accuracy, consistency, gaps in work history, relevant references, etc.
• Identify issues and initiate further data collection as needed.
• Track and trend audit and notify leadership to administer appropriate team members education and coaching.
• Manage multiple concurrent audits, plan audits, and related projects.
• Execute audit planning by performing research to assist in development of appropriate audit scope, audit programs, and testing procedures.
• Communicate effectively both orally and in writing sound conclusions supported by audit evidence and make recommendations to strengthen internal controls and increase efficiency, effectiveness and economy of operations.

Education:

• High school graduate or GED equivalent.
• Preferred:
  • Associates Degree

Experience:

• Minimum of 2 years of experience in the field of CVO Operations, PHO operations, auditing, primary source verification, or quality practices:
• Knowledge of the healthcare industry.
• Proficient in Microsoft Office Suite.
• Knowledge of regulatory agency standards (i.e., NCQA, URAQ, The Joint Commission, DNV, etc.).
• One year of credentialing auditing experience or similar
• Excellent communication skills both written and verbal.
• Preferred:

  • Current experience with credentialing of provider applications in an electronic platform.

  • Credentialing auditing experience.

License(s) Certification(s):

• CPCS certified or must obtain within one year of hire.
• Preferred:
  • CPCS Certified

Knowledge/Skills/Abilities:

• Work with sensitivity with confidential information on a continuous basis
• Proficiently use MS Office, including Word, Excel, PowerPoint, and Access (including ability to manage databases, develop charts, tables, graphs)
• Communicate well with a range of leaders and employees
• Employ excellent analytical abilities and to problem-solve
• Be well organized, attentive to detail, meet established deadlines, and work well under pressure.