Credentialing Auditor/Educator

AdventHealth

Tampa (FL)

On-site

USD 30,000 - 55,000

Full time

5 days ago

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Benefits offered by this job

Medical, Dental, Vision Insurance

Life Insurance

Disability Insurance

PTO from Day One

403(b) Retirement Plan

Parental Leave (4 weeks)

Job summary

AdventHealth in Tampa, Florida seeks an experienced Credentialing Auditor to perform comprehensive audits of credentialing, reappointment, and provider enrollment files, ensuring accuracy and regulatory compliance. The role supports onboarding, education, and SOP development for credentialing teams across multiple sites.

You will act as a subject-matter expert, create training resources, and drive continuous improvement in credentialing processes in a fast-paced hospital network.

Qualifications

Comprehensive understanding of credentialing, reappointment, including primary source verification and application review.

Responsibilities

Conduct comprehensive audits of credentialing, reappointment, and provider enrollment files to verify accuracy, completeness, and compliance with accreditation requirements, regulatory standards, and internal organizational policies.

Skills

Credentialing

Primary Source Verification

Audit Reports

Attention to Detail

Training & Education

Communication

Independent & Collaborative

Education

High School Diploma or Equiv

Bachelor's Degree (Preferred)

Job description

Our Promise To You

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that

Our Promise To You

All the benefits and perks you need for you and your family:

Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance
Paid Time Off from Day One
403-B Retirement Plan
4 Weeks 100% Paid Parental Leave
Career Development
Whole Person Well-being Resources
Mental Health Resources and Support
Pet Benefits

Schedule

Full time

Shift

Day (United States of America)

Address

3100 E FLETCHER AVE

City

TAMPA

State

Florida

Postal Code

33613

Job Description

Conduct comprehensive audits of credentialing, reappointment, and provider enrollment files to verify accuracy, completeness, and compliance with accreditation requirements, regulatory standards, and internal organizational policies.
Identify errors, inconsistencies, and process gaps during audits, and prepare clear, detailed audit reports outlining findings, trends, and recommended corrective actions.
Participate in the preparation and support of audit documentation for submission to regulatory agencies, ensuring all required materials are accurate and complete.
Develop, update, and maintain audit criteria and checklists, and recommend operational improvements to enhance credentialing processes and compliance.
Create, implement, and facilitate onboarding training programs for new credentialing team members, as well as ongoing training focused on credentialing standards, system workflows, and industry best practices.
Design and produce educational resources, including job aids, standard operating procedures (SOPs), and reference guides, to support staff in maintaining credentialing excellence.
Deliver targeted training sessions based on audit findings and staff performance trends to address specific areas of need and promote continuous improvement.
Serve as a resource and subject-matter expert on credentialing standards, providing guidance and support to credentialing teams as needed.
Collaborate with team leads and other stakeholders to ensure consistency and alignment in credentialing processes across multi-site, multi-state CVO operations.
Performs other duties as assigned.

Knowledge, Skills, And Abilities

Comprehensive understanding of credentialing, reappointment, including primary source verification, application review [Required]
Ability to work independently and collaborative in a high-volume, fast-paced environment. [Required]
Advanced attention to detail with a high degree of accuracy and quality control [Required]
Excellent written and verbal communication skills [Required]
Ability to train and education staff [Required]
Experience conducting audits in a CVO or managed-care environment [Preferred]
Experience developing training programs, SOPs [Preferred]
Experience supporting provider enrollment audits [Preferred]

Education

High School Grad or Equiv [Required]
Bachelor's [Preferred]

Work Experience

3+ years in hospital credentialing, managed care credentialing, and/or provider enrollment experience [Required]
3+ years MD Staff experience [Preferred]

Licenses And Certifications

Certified Provider Credentialing Specialist (CPCS) [Preferred]
Certified Professional Medical Staff Management (CPMSM) [Preferred]

Physical Requirements

(Please click the link below to view work requirements)

Physical Requirements - https://tinyurl.com/mte9kpcf

Pay Range

$21.73 - $40.42

Background Screening Requirement (Florida Law)

Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law. Applicants may review general information about Florida’s background screening requirements at the Florida Care Provider Background Screening Clearinghouse: https://info.flclearinghouse.com/

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

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