Delegated Credentialing QA Coordinator
New
A
AnswersNow IncAutism Therapy
Remote, Anywhere in the USFull-TimeMiddle
Salary72,000 - 84,000 USD per year
Apply NowOpens the employer's application page
Job Details
- Required Skills
- QADocumentationCompliance
Requirements
- Experience with delegated credentialing processes, specifically for BCBA or behavioral health providers.
- Knowledge of NCQA and CMS regulatory and accreditation standards.
- Proficiency in conducting routine and ad hoc file audits for compliance.
- Ability to manage and maintain audit tools, checklists, and reporting dashboards.
- Experience monitoring delegated entities for contractual and documentation adherence.
- Ability to assist in the development and delivery of training materials for internal teams.
- Strong attention to detail for reviewing provider packets and primary source verification.
- Ability to collaborate with cross-functional teams including Enrollment Submission and Contracting.
Responsibilities
- Examine BCBA and behavioral health provider files for completeness, accuracy, and primary source verification.
- Build and update audit checklists, tracking spreadsheets, and reporting dashboards.
- Create, update, and deliver training materials for internal staff and delegated entities regarding compliance expectations.
- Monitor delegated entities to confirm they meet turnaround times, documentation standards, and verification obligations.
- Review internal credentialing policies to ensure alignment with current regulatory, accreditation, and payer-specific standards.
- Support audit readiness for new state licenses and payer networks to facilitate market expansion.
View Full Description & ApplyYou'll be redirected to the employer's site
