Professional, Credentialing QC Analyst

Mvp Health Plan Inc•Rochester, NY

57d•Remote

About The Position

Your key responsibilities: Conduct thorough quality control reviews of credentialing/recredentialing files and documentation. Verify credentials, licenses, certifications, and other required documentation for accuracy and compliance. Collaborate with credentialing specialists to resolve discrepancies and ensure timely updates. Maintain detailed records of QC findings and corrective actions. Assist in developing and refining QC procedures and checklists. Monitor compliance with internal policies, accreditation standards, and regulatory requirements. Provide feedback and training to credentialing staff on quality standards and best practices. Support audits and reporting requirements related to credentialing activities. Stay current with industry standards, regulations, and credentialing best practices. Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.

Requirements

Associate's or Bachelor's degree in a related field (e.g., healthcare administration, business, or HR) preferred.
2+ years of experience in credentialing, compliance, or quality assurance.
Strong attention to detail and analytical skills.
Familiarity with credentialing software and databases.
Excellent communication and organizational skills.
Ability to work independently and collaboratively in a fast-paced environment.
Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
Understanding of data privacy and confidentiality standards.
Curiosity to foster innovation and pave the way for growth
Humility to play as a team
Commitment to being the difference for our customers in every interaction

Nice To Haves

Experience in healthcare or insurance credentialing preferred.
Knowledge of regulatory standards (e.g., NCQA, URAC, Joint Commission) is a plus.

Responsibilities

Conduct thorough quality control reviews of credentialing/recredentialing files and documentation.
Verify credentials, licenses, certifications, and other required documentation for accuracy and compliance.
Collaborate with credentialing specialists to resolve discrepancies and ensure timely updates.
Maintain detailed records of QC findings and corrective actions.
Assist in developing and refining QC procedures and checklists.
Monitor compliance with internal policies, accreditation standards, and regulatory requirements.
Provide feedback and training to credentialing staff on quality standards and best practices.
Support audits and reporting requirements related to credentialing activities.
Stay current with industry standards, regulations, and credentialing best practices.
Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.