L.A. Care Health Plan Credentialing Auditor in Los Angeles, California

DUTIES

The Credentialing Auditor ensures compliance of the Plan Partners (PPs) and/or Participating Physician Groups (PPGs) maintain regulatory, contractual and L.A. Care requirements. The Credentialing Auditor is responsible for performing annual and focused audits and continuous monitoring activities. This position also acts as a liaison between the PPs and/or PPGs and L.A. Care regarding credentialing issues. This position will develop standardized reports, independent analysis of audit results, credentialing data and activities; reports will be submitted to the Chief of Operations, Credentialing Subcommittee, Quality Management Committee, and Board of Governors. This position is responsible for interacting and coaching activities to improve overall compliance with PPs, PPGs, internal and external parties, upper management, and vendors in order to facilitate solutions and promote credentialing agendas. The Credentialing Auditor will assist with the development of policies and procedures within the department.

QUALIFICATIONS & REQUIREMENTS

EDUCATION: Required: High School Diploma

Preferred: Associates Degree

LICENSES/CERTIFICATIONS Preferred: Provider Credentialing Specialist (CPCS)

EXPERIENCE: Required: With HS Diploma: At least 4-5 years of credentialing experience in managed care or hospital.

With Associate's Degree: At least 3-4 years of credentialing experience in managed care or hospital.

Analytical and detailed. Excellent time management skills with the ability to multitask projects Knowledge of database management and credentialing software. Knowledgeable of reporting formats. Excellent in written and verbal communications.

Preferred: Strong knowledge of NCQA standards

Job Title: Credentialing Auditor

Job Category: Administrative & Business Professionals

Department: Credentialing

Location: Headquarters, Downtown Los Angeles

Position Type: Full-time

Position Control Number: 036D

Pay Grade: H