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Credentialing Auditor
Astiva Health - Orange, CA
posted about 2 months ago
About the position
The Credentialing Auditor at Astiva Health, Inc. is responsible for conducting audits related to credentialing and ensuring compliance with various healthcare standards. This role involves performing pre-delegation and annual audits, tracking and analyzing reports, and participating in collaborative meetings to enhance credentialing processes. The position requires travel across California for onsite audits and necessitates a strong understanding of Medicare and health plan credentialing.
Responsibilities
- Coordinate and conduct pre-delegation and annual audits/credentialing IPA due diligence audits.
- Prepare audit reports and follow up on corrective action plans (CAP) as applicable.
- Review and process initial credentialing applications and update recredentialing applications.
- Maintain provider data in the credentialing database and ensure continuous data maintenance.
- Track, analyze, and report on IPA's quarterly credentialing reports to the Delegation Oversight Committee (DOC).
- Assist Compliance with reports to federal and state agencies as required.
- Prepare and present credentialing activities for oversight audits, state, and federal audits.
- Participate in ICE monthly meetings and assist with general credentialing activities.
Requirements
- High School diploma or GED required.
- Bachelor's degree in Healthcare Administration, Finance, Business Administration or related field or a combination of education and experience.
- 5 years previous experience in a credentialing role within a health plan, IPA, or medical group strongly desired.
- Strong working knowledge of Medicare, Medicaid, and health plan credentialing required.
- Proficient in Microsoft Office including Word, Excel, and Outlook.
- Valid CA Driver's License and proof of auto insurance coverage.
Nice-to-haves
- Stellar critical thinking skills with the ability to independently research complex issues.
- Professional communication skills with internal teams and external providers.
Benefits
- 401(k)
- Dental Insurance
- Health Insurance
- Life Insurance
- Vision Insurance
- Paid Time Off
