Senior Facility Credentialing Lead – Compliance & Audits

HealthFirst; Bismarck (ND); On-site; USD 42,000 - 64,000; Full time

Job summary

HealthFirst seeks a Credentialing Specialist to manage provider, facility, and vendor credentialing and re-credentialing, ensuring accuracy and compliance with state and federal regulations. The role includes preparing hard-copy directories and facilitating audits.

Responsibilities also cover presenting at quarterly credentialing meetings, communicating with internal teams and external partners, and driving process improvements to uphold regulatory standards.

Qualifications

• HS diploma or GED required.
• Bachelor’s degree preferred.
• Experience in credentialing and project management.
• Strong communication and problem-solving skills.

Responsibilities

• Credential providers, facilities, and vendors in accordance with regulations and HealthFirst policy.
• Prepares presentations for quarterly credentialing and delegate vendor oversight committee meetings.
• Facilitates pre-delegation and delegation vendor audits to ensure contractual adherence.
• Prepares hard-copy directories and coordinates with third-party vendors for online directories.
• Reviews relevant data to ensure accuracy and compliance with state and federal regulations.
• Identifies opportunities to improve processes to better ensure regulatory compliance.
• Raises issues to management and assists in resolution.
• Assists with additional duties as assigned.

Skills

Attention to detail

Regulatory compliance

Communication

Education

HS diploma/GED

Bachelor’s degree preferred

Job description

HealthFirst seeks a Credentialing Specialist to manage provider, facility, and vendor credentialing and re-credentialing, ensuring accuracy and compliance with state and federal regulations. The role includes preparing hard-copy directories and facilitating audits.

Responsibilities also cover presenting at quarterly credentialing meetings, communicating with internal teams and external partners, and driving process improvements to uphold regulatory standards.