The Credentialing Auditor will be handling continuing checks to ensure that all credentialing paperwork is up to date, submitted, and accurate. They will be in charge of all quarterly audits of insurance paperwork.
Essential Functions
- Audit a minimum of two insurance rosters per month. Will be responsible for obtaining the rosters from insurance
- Follow up on previous submissions after 14 days to assure they were received.
- Audit insurance rosters to compare to our records in Hopebridge Charts.
- Handle quarterly audits for CAQH, Availity, UHC, Beacon, etc. to ensure accuracy.
- Maintain a clear criminal record
Competencies
- Time Management
- Communication
- Customer Service
- Attention to Detail
- Ability to follow processes and procedures
Required Education and Experience
- High School Diploma or GED
Preferred Education and Experience
- Associates or bachelor’s degree
- Knowledge of credentialing
- Previous experience working in healthcare
- Working knowledge and understanding of provider enrollment
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is regularly required to talk or hear. This is largely a sedentary role; however, some filing is required. This would require the ability to lift files, open filing cabinets and bend or stand on a stool as necessary.
Work Environment
While performing the duties of this job, the employee regularly works in an office setting.
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.?
Disclaimer
The above statements reflect general functions of this job and shall not be construed as a detailed description of all work requirements inherent in this job. The immediate supervisor may elaborate on or add to the above list if the duties come within the employee’s realm of responsibility.
Hopebridge is an Equal Opportunity Employer that does not discriminate on the basis of actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, arrest record or any other characteristic protected by applicable federal, state or local laws.