Northeast Georgia Health System (NGHS)
Specialist-Quality & Credentialing
Gainesville, GA
Sponsorship not specified$66k-$100kDetected 10 hours ago
ExcelCommunicationProblem Solving
About the role
- Shall serve as the content expert in matters regarding quality improvement and provider credentialing.
- Shall be the primary contact for regulatory standard questions related to quality improvement and credentialing.
- Shall conduct the annual access & availability study as part of the organization's network development efforts.
Responsibilities
- Maintains working files in an organized secure fashion.
- Arranges site visits to provider offices to perform quality assessments as defined in the QI program.
- Maintains a defined process for conducting, evaluating and reporting on-site quality assessments.
- Shall manage the distribution, tabulation, communication and follow-up activity regarding the satisfaction tool.
- Manages the administration of the patient satisfaction survey in accordance with the QI workplan.
- Responsible to ensure compliance with NCQA credentialing standards to maintain certification by way of audit and oversight.
- Leads the on-site review process.
- Maintains and updates the provider e-directory.
- Maintains an organized provider file including all necessary information outlined in the Credentialing Program.
- Leads and/or participates in other committees as assigned.
Requirements
- Bachelors Degree or equivalent with six (6) to eight (8) years of relevant experience.
- Minimum Experience: Minimum of six (6) years experience in a large group practice or managed care setting responsible for Quality Improvement and credentialing activities.
- Knowledge of the regulatory standards of JCAHO for PPOs, URAC and NCQA
- Knowledge of various computer programs such as Word and Excel
- Coordinates the activities required to successfully achieve external accreditation with NCQA.
Nice to have
- Preferred Job Qualifications
- Preferred Licensure or other certifications:
- Preferred Experience:
Skills
- Shall utilize effective problem solving skills to resolve performance issues.
- Job Specific and Unique Knowledge, Skills and Abilities
- Assessment and problem solving skills
- Detail and deadline oriented with strong follow-up skills
- Effective verbal and written communication skills
Compensation
- Drafts the annual Quality Improvement program, including the workplan to present to the Quality Improvement Committee for approval.
- Maintains compliance with delegated credentialing agreements to include, but not limited to, preparing quarterly and annual metrics and performance reports for no less than nine delegated agreements.
- Responsible for invoicing and processing of annual provider network participation fees.
- Shall prepare the annual access and availability study as part of the organizations network development efforts.
- Responsible to develop the annual Quality Improvement workplan, lead the Quality Improvement committee and manage the activities outlined in the program.
Benefits
- Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.
- Vision: Heavy, Constantly 66-100% of time
- Provides in-services for providers and HP staff to promote education.
- Participates in organizational wide education efforts to promote QI and patient satisfaction expectations.
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This listing is sourced directly from Northeast Georgia Health System (NGHS)'s careers page and normalized into a canonical job model.