Provider Enrollment & Credentialing Documentation Auditor

General Dynamics Information Technology, Inc.; United States; Remote; USD 70,000 - 110,000; Full time

Benefits offered by this job

401K with company match

Paid time off

Flexible work arrangements

Comprehensive benefits

Job summary

General Dynamics Information Technology, Inc. is seeking a Provider Enrollment Certification Auditor/Documentation Specialist to lead documentation management, policy interpretation, and operations manuals alignment with NCQA, CMS, and regulatory standards.

The role emphasizes cross-functional collaboration, desk procedure development, and provider profile preparation for Credentialing Committee reviews within a fast-paced healthcare operations environment.

Qualifications

• Education: BA/BS or equiv.
• Experience: 2+ years of experience in technical writing, process documentation, healthcare operations, credentialing, provider enrollment, quality management, or a related field.
• Technical Skills: Microsoft Word, Excel, PowerPoint, and SharePoint; Process mapping and workflow documentation; Document version control and records management; Data analysis and reporting; Attention to detail and quality review.
• Role Requirements: Ability to interpret and document complex business processes; Strong organizational and project coordination skills; Excellent written and verbal communication skills; Experience supporting provider enrollment, credentialing, NCQA, CMS, or healthcare regulatory environments preferred; Ability to develop provider profiles and supporting documentation for Credentialing Committee review.

Responsibilities

• Create new and revise existing Desk Procedures (DPs), Policy Interpretations, Operations Manuals, and supporting documentation.
• Analyze business rule changes, policy updates, system enhancements, and operational process changes to determine documentation impacts.
• Review Functional Modification Requests (FMRs) submitted by customers and business stakeholders to identify required documentation updates.
• Collaborate with operational teams, business owners, leadership, and subject matter experts to gather information necessary for document development.
• Ensure all documentation is clear, concise, standardized, and follows established formatting and version control requirements.
• Maintain document inventories and repositories to ensure the most current versions are accessible to staff.
• Conduct routine audits of existing documentation to identify outdated processes, conflicting instructions, or areas requiring clarification.
• Track document revisions and maintain records of updates, approvals, and implementation dates.
• Review policy changes and regulatory requirements to assess operational impact.
• Meet with leadership to discuss proposed policy updates and required procedural modifications.
• Translate complex policy language into operational procedures and staff guidance.
• Ensure all documentation remains aligned with NC DHHS, NCQA, and organizational requirements.
• Provide recommendations for operational process improvements based on policy and regulatory changes.
• Serve as the primary departmental resource for locating and interpreting business rules, operational requirements, and procedural guidance documented within Desk Procedures and Operations Manuals.
• Respond to staff and leadership inquiries regarding documented processes and operational requirements.
• Provide guidance and clarification regarding procedure interpretation and policy application.
• Assist departments with identifying existing documentation before creating new processes.
• Create provider profiles for credentialing committee review.
• Review provider files and supporting documentation to ensure profile accuracy, completeness, and compliance with credentialing requirements.
• Analyze credentialing information and summarize findings for committee consideration.
• Perform quality reviews of provider profiles prior to committee presentation.
• Redact confidential, protected, or sensitive information in accordance with organizational policies and privacy requirements.
• Ensure provider profiles accurately reflect credentialing findings and required committee actions.
• Participate in daily provider profile review meetings with credentialing staff and leadership.
• Present provider profile content and address questions during review sessions.
• Collaborate with credentialing leadership to resolve profile discrepancies and documentation concerns.
• Prepare provider profiles for final presentation to the Credentialing Committee.
• Attend weekly Credentialing Committee meetings to provide documentation support and answer questions related to provider profiles, credentialing findings, and committee recommendations.
• Document committee feedback requiring profile updates or process improvements.
• Serve as backup to the Credentialing Committee Coordinator as needed.
• Assist with meeting preparation, agenda compilation, and committee materials.
• Support meeting scheduling and participant communications.
• Coordinate committee documentation, reports, and meeting packets.
• Assist with meeting minute preparation and distribution.
• Ensure committee records are maintained according to organizational and regulatory requirements.
• Support NCQA, CVO, and organizational quality initiatives.
• Update documentation to reflect accreditation standards, audit findings, corrective actions, and process improvements.
• Assist with preparation for accreditation surveys, audits, and compliance reviews.
• Participate in process improvement projects that impact departmental procedures and workflows.
• Collaborate with quality management and operational leadership to implement documentation-related corrective actions.
• Partner with Operations, Credentialing, Compliance, Quality, Information Technology, and Leadership teams to ensure documentation reflects current business practices.
• Participate in departmental meetings, workgroups, and project discussions related to operational changes.
• Support implementation activities by communicating documentation changes and providing education to impacted staff.
• Assist with training initiatives by developing procedural guidance and reference materials.
• Identify opportunities to improve document management processes and operational efficiency.
• Recommend enhancements to documentation standards, templates, and governance practices.
• Monitor trends, recurring questions, and audit findings to identify areas requiring additional documentation or clarification.
• Support strategic initiatives involving process redesign, system implementations, and workflow optimization.
• Key Deliverables: Desk Procedures (DPs), Policy Interpretations, Operations Manuals, FMR Documentation Updates, Provider Profiles, Credentialing Committee Materials, NCQA/CVO Documentation Updates, Process Flow Documentation, Training and Reference Materials

Skills

Documentation management

Process mapping

Data analysis

Attention to detail

Verbal and written communication

Project coordination

Education

BA/BS or equiv.

Tools

Microsoft Word

Excel

PowerPoint

SharePoint

Job description

General Dynamics Information Technology, Inc. is seeking a Provider Enrollment Certification Auditor/Documentation Specialist to lead documentation management, policy interpretation, and operations manuals alignment with NCQA, CMS, and regulatory standards.

The role emphasizes cross-functional collaboration, desk procedure development, and provider profile preparation for Credentialing Committee reviews within a fast-paced healthcare operations environment.