Specialist-Quality & Credentialing
On-siteGainesville, Georgia, United States
Job Summary
Develop the annual Quality Improvement workplan and lead the Quality Improvement committee while managing delegated credentialing activities and audit processes. Conduct on-site quality reviews, perform primary source verification for providers, and coordinate facility eligibility assessments. Prepare quarterly and annual metrics reports, manage patient satisfaction surveys, and ensure compliance with NCQA standards for accreditation. Serve as the primary contact for regulatory questions and collaborate with Risk Management and Infection Control personnel. Maintain organized provider files, update policy manuals, and facilitate provider education sessions.
Required Qualifications
- Bachelors Degree or equivalent
- six (6) to eight (8) years of relevant experience
- Minimum of six (6) years experience in a large group practice or managed care setting responsible for Quality Improvement and credentialing activities
- Licensure or other certifications
- Knowledge of the regulatory standards of JCAHO for PPOs, URAC and NCQA
- Knowledge of various computer programs such as Word and Excel
- Up to 20 lbs
- Up to 20 lbs
- Heavy, Constantly 66-100% of time
- Kneeling/Stooping/Bending: Occasionally 0-30% of time
- Standing/Walking: Occasionally 0-30%
- Pushing/Pulling: Occasionally 0-30%
- Reading
- Writing
- Reasoning
- Talking
- Keyboarding
Desired Qualifications
- Assessment and problem solving skills
- Detail and deadline oriented with strong follow-up skills
- Organized
- Effective verbal and written communication skills
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