CREDENTIALING FILE AUDITOR
: Job Details :

Job Location: Remote/Hybrid, Seattle - South Lake UnionPosting Date: 12/09/2024Closing Info: Open Until FilledShift: First ShiftAs a UW employee, you will enjoy generous benefits and work/life programs. For a complete description of our benefits for this position, please visit our website.The School of Medicine has two outstanding opportunities for a Credentialing File Auditor to join their team.UW Medicine's programs encompass advanced medical diagnostics, treatment services, and clinical support for educating medical students, as well as postgraduate trainees. Additionally, UW Medicine maintains one of the largest university-based research programs in the U.S. and provides care to underserved and disadvantaged populations, supporting the economic vitality of UW Medicine's health system.OMSA is mission critical to UW Medicine which generates over $4B per year in revenue. Medical staff at Harborview Medical Center, UW Medical Center(s), and Fred Hutchinson Cancer Center cannot work unless they are properly credentialed and privileged in a timely fashion. Credentialing and privileging records are audited regularly by the Department of Health (DOH), The Joint Commission (TJC), and other external regulatory and accreditation agencies.Under the general guidance of the Director of System Credentialing, the Credentialing File Auditor audits medical staff credentialing and privileging files for UW Medicine, which includes UW Medical Center(s), Harborview Medical Center, Fred Hutchinson Cancer Center, UW Medicine Primary Care Clinics, and UW Husky Health.The Credentialing Auditor is responsible for conducting comprehensive audits of credentialing and privileging processes to ensure compliance with internal policies, accreditation standards, and regulatory requirements. This role involves the review and evaluation of credentialing files for completeness, accuracy, and adherence to established guidelines and regulatory requirements. The auditor will collaborate with department leadership to identify and recommend corrective actions, process improvements, and training opportunities.DUTIES AND RESPONSIBILITIESCredentialing Files Audit: 70%:

Conduct detailed audits of credentialing and privileging files submitted by the credentialing staff to verify the accuracy of information and compliance with organizational, accreditation, and regulatory standards (e.g., The Joint Commission, NCQA, CMS, etc.). Perform follow-up reviews to ensure identified issues are resolved and improvements are sustained.

Ensure credentialing activities meet regulatory requirements, including primary source verifications, licensure, certifications, and malpractice history.

Stay up to date with changes in laws, regulations, and standards affecting credentialing and ensure the organization remains compliant with these changes.

Assist in developing and providing training to credentialing staff on updated policies, procedures, and best practices related to credentialing and auditing.

Partner with various departments, including compliance, quality assurance, and medical staff services, to ensure consistency and alignment in credentialing practices.

Ensure all credential documentation is properly stored, easily retrievable, and kept confidential as required by law.Reporting, Process Improvement, and Quality Assurance: 20%:

Document audit results to inform key performance metrics for the OMSA Productivity Dashboard.

Identify any gaps in documentation or evaluation processes and work with relevant teams to implement corrective actions as needed.

Share file review revisions and/or areas of concern to the Credentialing Manager.

Provide recommendations for corrective action where necessary.

Provide regular updates to the Associate Director and Director on quality of files and team performance.

Identify trends in errors or non-compliance and suggest process improvements to enhance the quality of credentialing functions.

Work closely with the credentialing team to implement these improvements.

Analyze credentialing data and audit results to provide leadership with insights into trends, risks, and areas for improvement.Other duties as assigned: 10%:

OMSA is a collaborative unit with a focus on teamwork. During periods of peak hiring seasons, file auditors may be asked to help with credentialing and privileging and various other projects as assigned by the Manager, Associate Director, or Director.MINIMUM REQUIREMENTS

Bachelor's degree in health administration, business administration, or a related field is required.

Minimum of 3 years of experience in credentialing, healthcare compliance, or medical staff services.

Equivalent education/experience will substitute for all minimum qualifications except when there are legal requirements, such as a license/certification/registration.ADDITIONAL REQUIREMENTS

Knowledge of credentialing standards and regulations (e.g., TJC, NCQA, URAC).

CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional Medical Services Management) preferred or willingness to obtain within 2 years of hire date.

Strong attention to detail and analytical skills.

Time management and efficiency.

Excellent written and verbal communication skills.

Proficiency in credentialing software systems (e.g., MSOW and MD Staff) and Microsoft Office Suite.

Ability to work independently and manage multiple priorities.DESIRED QUALIFICATIONS

Experience in an auditing or quality assurance role is preferred.WORK ENVIRONMENT

Standard office environment.Application Process: The application process may include completion of a variety of online assessments to obtain additional information that will be used in the evaluation process. These assessments may include Work Authorization, Cover Letter and/or others. Any assessments that you need to complete will appear on your screen as soon as you select Apply to this position . Once you begin an assessment, it must be completed at that time; if you do not complete the assessment, you will be prompted to do so the next time you access your My Jobs page. If you select to take it later, it will appear on your My Jobs page to take when you are access ready. #J-18808-Ljbffr