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Credentialing Quality Control Analyst


Reference Number: SMRIAI2

Credentialing Quality Control Analyst
experience  Not Disclosed
location  Woonsocket, RI (100% Remote)
duration  6.0 Months
salary  Not Disclosed
jobtype  Not Disclosed
Industry  Healthcare
duration  $-4/hour - $1/hour
Job Description

Fully remote (never coming onsite)

Position Summary
Client is seeking an analyst experienced in health care or health plan compliance monitoring and auditing to join our Credentialing and Payer Delegation team. This position supports the credentialing compliance monitoring program activities, auditing, data collection, trend analysis and meeting timeliness for delegated payer deliverables.

Participates in the development and ongoing implementation of quality improvement activities. Improve quality products and services, by using measurements and analysis to process, evaluate and make recommendations to meet QM compliance objectives
Conducting ongoing monitoring to evaluate levels of regulatory credentialing and delegated payer compliance with contractual and requirements
Performing credentialing business process functions as needed, and credentialing documentation audits
Assist with credentialing tasks as needed
Reviewing risk assessments while participating in ongoing monitoring and annual identification of areas where there can be process improvement
Building and maintaining effective, positive internal and external customer relationships
Participating in team initiatives and projects and meeting deadlines and quality expectations
Exhibiting client at Work Behaviors

Duties
Client is seeking an analyst experienced in health care or health plan credentialing, compliance monitoring and auditing to join our Credentialing and Payer Delegation team. This position supports the credentialing compliance monitoring program activities, auditing, data collection, trend analysis and meeting timeliness for delegated payer deliverables.

Assists in the preparation of deliverables for payer and internal audit requests
Communicating professionally and respectfully in all forms of interaction
Works independently and meet deadlines with high quality and accuracy
Assist with credentialing tasks and collaborative projects as needed
Performing credentialing business process functions as needed, performing scheduled and random credentialing file audits
Reviewing risk assessments while participating in ongoing monitoring and annual program evaluation and identification of areas where there can be process improvement

Experience
3+ years of related health care or health plan experience in credentialing compliance, auditing, and quality assurance
The ability to read, write, understand and apply written and verbal instructions with minimal assistance afterwards.
Proficiency in Microsoft Office Applications; Excel, Outlook, Word, and Teams
The ability to review, analyze, update data on shared spreadsheets and identify trends.
Strong attention to detail and the ability to multi-task in a fast-paced environment
MDStaff experience is preferred
2 years’ experience with NCQA compliance
1 year MDStaff experience.
Independent time management in a work from home environment


Education
Bachelor Degree Required

Notes:
Mon-Fri 8:30a-5p EST (Training will be Mon-Fri 9a-430p for approximately 2 weeks)
Fully remote (never coming onsite)


VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status

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