Credentialing Auditor/Educator

AdventHealth; Tampa (FL); On-site; USD 30,000 - 56,000; Full time

Benefits offered by this job

Benefits from Day One

Paid Time Off

403-B Retirement Plan

Parental Leave

Career Development

Well-being Resources

Mental Health Resources

Pet Benefits

Job summary

AdventHealth in Tampa, FL, is seeking a Credentialing Auditor to ensure accuracy and compliance across credentialing, reappointment, and provider enrollment files. The role involves analyzing audit findings, creating training programs, and supporting regulatory submissions.

You will develop standard operating procedures, educate staff on credentialing standards, and collaborate with multi-site teams to uphold accreditation and payer requirements.

Qualifications

• 3+ years in hospital credentialing, managed care credentialing, or provider enrollment.
• Experience with primary source verification and credentialing audits.
• Ability to train staff and develop SOPs.
• Strong written and verbal communication skills.
• Preferred CPCS or CPMSM certifications.

Responsibilities

• Audit credentialing, reappointment, and provider enrollment files for accuracy and compliance.
• Identify errors, gaps, and trends; produce detailed audit reports with corrective actions.
• Prepare and support audit documentation for regulatory submissions.
• Develop and maintain audit criteria and checklists; propose process improvements.
• Create onboarding and ongoing training programs for credentialing staff; produce SOPs and reference guides.
• Deliver targeted trainings based on audits and performance trends.
• Collaborate with team leads to ensure consistency across multi-site operations.
• Perform other duties as assigned.

Skills

Primary source verification

Attention to detail

Verbal communication

Training staff

Independent work

Auditing experience

Education

High School diploma

Bachelor’s degree

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 together we are even better.

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.