What are the responsibilities and job description for the Provider Relations Auditor position at Group Health Cooperative of Eau Claire?
Position Purpose
To assist the Provider Relations department in conducting annual and periodic audits to assure accuracy in Credentialing and Network Management as defined by management of the department.
Essential Position Functions
To assist the Provider Relations department in conducting annual and periodic audits to assure accuracy in Credentialing and Network Management as defined by management of the department.
Essential Position Functions
- To create and maintain a systematic approach to the various audits and complete audits timely. Audits to include, but not limited to:
- Review and audit Monthly Credentialing and Re-credentialing.
- Review and audit Annual delegated credentialing.
- Review and audit Annual Credentialing systems controls audit.
- Review and audit Annual directory.
- Review and audit Organizational assessment.
- Complete NCQA-required interdepartmental audits as assigned.
- Comply with all company policies and procedures.
Minimum Requirements of the Position
- High school graduate or equivalent.
- Provider contracting/Credentialing experience or prior experience as an auditor preferred.
- Proficient in the use of Microsoft Word and Excel.
- Excellent communication skills, strong attention to detail, good time management and organizational skills required.
Group Health Cooperative of Eau Claire complies with applicable Federal civil rights laws and does not discriminate, exclude or treat candidates less favorably on the basis of race, color, national origin (including limited English proficiency and primary language), age, disability, or sex (including sex characteristics, including intersex traits; pregnancy or related conditions; sexual orientation; gender
identity; and sex stereotypes).
The Cooperative is committed to fostering a caring and compassionate environment while ensuring that individual differences are valued. The Cooperative is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. It is essential that all employees and members feel secure and welcome, that the opinions and contributions of all individuals are respected and that all voices are heard.
This full time position offers an outstanding benefit package, including three weeks of vacation the first year, a generous retirement plan, health and dental insurance, a wellness program, and much more! If you are interested in working for an organization focused on a team atmosphere and is dedicated to providing exceptional service submit your resume today! Send resume to: resumes@group-health.com. Group Health Cooperative of Eau Claire is an affirmative action and equal opportunity employer.
identity; and sex stereotypes).
The Cooperative is committed to fostering a caring and compassionate environment while ensuring that individual differences are valued. The Cooperative is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. It is essential that all employees and members feel secure and welcome, that the opinions and contributions of all individuals are respected and that all voices are heard.
This full time position offers an outstanding benefit package, including three weeks of vacation the first year, a generous retirement plan, health and dental insurance, a wellness program, and much more! If you are interested in working for an organization focused on a team atmosphere and is dedicated to providing exceptional service submit your resume today! Send resume to: resumes@group-health.com. Group Health Cooperative of Eau Claire is an affirmative action and equal opportunity employer.
