Quality Management Credentialing Specialist

2 days ago


Philadelphia, Pennsylvania, United States Insight Global Healthcare Full time
Job Title: Quality Management Credentialing Analyst

We are seeking a highly skilled Quality Management Credentialing Analyst to join our team at Insight Global Healthcare. As a key member of our Final Optical Check Quality Management team, you will work closely with the credentialing team and Board Committee to develop and update policies, audit and review processes, and build a strong provider base in both physical and behavioral health fields.

Key Responsibilities:

  • Develop, implement, and facilitate the regulatory and accreditation credentialing investigation process.
  • Identify and analyze high-risk, high-volume, and problem-prone credentialing processes to mitigate risk and improve provider satisfaction.
  • Recommend a plan of corrective action for resolution and follow up on adverse trends identified via data analysis.
  • Ensure compliance with NCQA accreditation, CMS state and federal laws/regulations, and internal policies.

Requirements:

  • 3-5 years of experience in credentialing, supporting either a Medical Staff Office or Provider Enrollment team.
  • Working experience/knowledge of NCQA and CMS standards.
  • High School Diploma.

Nice to Have:

  • Bachelor's Degree.
  • Clinical License.


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