Job description
Overview:
Summary
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.
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 Responsibilities:
Continuous Process Improvement
This position is open to remote/work from home with strong preference for candidates residing within the UPH geographies of Iowa, Illinois, & Wisconsin.
Summary
This position will be under the direction of the Physician Hospital Organization (PHO)/Medimore. Collaboration would be with the CVO. 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.
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 aTop 150 Place to Work in Healthcare 2022 by Becker’s Healthcare for our commitment to our team members.
- Culture – At UnityPoint Health, you 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 like 401K match, paid time off and education assistance 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
Credentialing File Auditing
- 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.
Continuous Process Improvement
- Build and maintain collaborative relationships with CVO and PHO team members, stakeholders,
and leadership at both the System Services and regional affiliate levels.
- Participate in workgroups as requested advising on system-wide credentialing matters.
- Utilize system software to efficiently research, document and test areas of risk.
- Facilitate departmental process enhancement initiatives.
- Maintain a high level of organization and planning in order to complete assigned projects within
designated timeframes.
- Research and utilize outside resources to maintain and update knowledge of healthcare and audit
issues.
- Provide audit data to track and trend improvement opportunities for the CVO and PHO/Medimore.
- Review information for accuracy and reconciles data on a regular basis.
Education
- High School Diploma or GED required
- Associates degree preferred
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
Licensure/Cerification
- CPCS certified or must obtain within one year of eligibility
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