Quality Management Credentialing Specialist
2 days ago
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.
-
Credentialing Specialist
4 weeks ago
Philadelphia, Pennsylvania, United States Resources For Human Development Full timeJob TypeFull-timePosition TitleCredentialing SpecialistReports toDirector of Financial OperationsOrganizational OverviewResources for Human Development is dedicated to providing comprehensive support services that enhance the quality of life for individuals and families. We believe in the importance of accessible, high-quality care delivered with compassion...
-
Credentialing Specialist
1 day ago
Philadelphia, Pennsylvania, United States Jefferson Health Full timeJob SummaryWe are seeking a highly skilled Credentialing Specialist to join our team at Jefferson Health. As a key member of our medical staff, you will be responsible for ensuring the integrity of our credentialing program and facilitating the privileging process for physicians and adjunct professionals.Key ResponsibilitiesManage all aspects of...
-
Credentialing Specialist
4 weeks ago
Philadelphia, Pennsylvania, United States COMHAR, Inc. Full timePosition OverviewAt COMHAR, Inc., our commitment is to deliver health and human services that empower individuals, families, and communities to achieve healthier, self-directed lives. We offer a comprehensive range of recovery-oriented and quality-focused services, including outpatient treatment and residential support, designed to provide high-quality...
-
Credentialing Specialist
1 day ago
Philadelphia, Pennsylvania, United States Temple University Full timeJob SummaryWe are seeking a highly skilled Credentialing Specialist to join our team at Temple University Hospital. As a key member of our healthcare operations team, you will be responsible for preparing and submitting credentialing applications and supporting documentation for medical staff and advanced practice providers.Key ResponsibilitiesPrepare and...
-
Credentialing Specialist
2 weeks ago
Philadelphia, Pennsylvania, United States Temple University Full timeJob SummaryWe are seeking a highly skilled Credentialing Specialist to join our team at Temple University Hospital. As a key member of our healthcare operations team, you will be responsible for ensuring the integrity of our provider database and facilitating the credentialing process for medical staff and advanced practice providers.Key...
-
Healthcare Credentialing Manager
1 day ago
Philadelphia, Pennsylvania, United States Jefferson Health Full timeJob Title: Central Enrollments Department ManagerJefferson Health seeks an experienced professional to lead the Central Enrollments department, responsible for the operations of health plan enrollment and physician credentialing. This role requires strong leadership and management skills, as well as expertise in healthcare credentialing and billing.Key...
-
Medical Quality Assurance Specialist
10 hours ago
Philadelphia, Pennsylvania, United States QTC Management Full timeJob Title: Medical Quality Assurance SpecialistWe are seeking a highly skilled Medical Quality Assurance Specialist to join our team at QTC Management. As a Medical Quality Assurance Specialist, you will play a critical role in ensuring the accuracy and completeness of medical documentation.Job Summary:The Medical Quality Assurance Specialist will be...
-
Quality Management Specialist
4 days ago
Philadelphia, Pennsylvania, United States Community Behavioral Health. Full timeJob SummaryCommunity Behavioral Health is seeking a Quality Management Specialist to assist in the daily operation of our Quality Management processes. This role entails tracking, trending, and resolving significant incidents and quality concerns.Key ResponsibilitiesAssist in the tracking and trending of all reported quality issues and produce trend...
-
Credentialing Administrator
4 weeks ago
New Philadelphia, Pennsylvania, United States COMHAR Full timeAt COMHAR, our commitment is to deliver health and human services that empower individuals, families, and communities to achieve healthier, self-directed lives. We offer a comprehensive range of recovery-oriented and quality-focused services, including outpatient treatment, residential care, and day services designed to provide high-quality support tailored...
-
Quality Assurance Specialist
2 days ago
Philadelphia, Pennsylvania, United States Meet Full timeQuality Assurance Engineering SpecialistMeet our growing Biotech client, seeking a Quality Assurance Engineering Specialist/Senior level to join their team in Philadelphia, PA.Job Summary:As a Quality Assurance Engineering Specialist in the pharmaceutical industry, you will play a critical role in ensuring the quality and compliance of our products...
-
Credentialing Operations Coordinator
4 weeks ago
New Philadelphia, Pennsylvania, United States COMHAR Full timeAbout COMHAR:At COMHAR, we are dedicated to delivering health and human services that empower individuals, families, and communities to achieve healthier, self-directed lives. Our organization offers a comprehensive range of recovery-oriented and quality-focused services, from outpatient treatment to residential and day programs, all designed to provide...
-
Quality Assurance Manager
1 week ago
Philadelphia, Pennsylvania, United States Jacobs Management Group, Inc. Full timeQuality Assurance ManagerAbout the Role:We are seeking an experienced Quality Assurance Manager to join our team at Jacobs Management Group, Inc. in Philadelphia, PA. As a key member of our Quality Department, you will play a pivotal role in expanding our quality initiatives and supporting audit operations.Key Responsibilities:Lead quality initiatives and...
-
Educational Quality Specialist
4 weeks ago
Philadelphia, Pennsylvania, United States Brightside Academy Full timeAbout Brightside Academy:Brightside Academy is a prominent provider of early childhood education services, committed to fostering a secure and supportive atmosphere that emphasizes child growth and development. Our facilities are modern, and our curriculum is nationally recognized.Key Responsibilities of the Educational Quality Specialist:Ensure the...
-
Risk Management and Quality Assurance Specialist
3 weeks ago
Philadelphia, Pennsylvania, United States Temple Health Full timeJob Summary:The Patient Safety and Risk Management Specialist will be responsible for ensuring the highest level of patient safety and quality of care at Temple Health. This role will involve data entry, reporting, and analysis to identify areas for improvement. The successful candidate will have a strong background in risk management, quality assurance, and...
-
Quality Assurance Specialist
2 weeks ago
Philadelphia, Pennsylvania, United States Elbit Systems Full timeJob SummaryWe are seeking a highly skilled Quality Assurance Specialist to join our team at Elbit Systems. As a Quality Assurance Specialist, you will be responsible for ensuring the quality of our products and services, and for implementing processes and procedures to improve our quality management system.Key ResponsibilitiesConduct inspections and tests to...
-
Quality Assurance Specialist
2 weeks ago
Philadelphia, Pennsylvania, United States Elbit Systems of America Full timeJob SummaryWe are seeking a highly skilled Quality Assurance Specialist to join our team at Elbit Systems of America. As a Quality Assurance Specialist, you will be responsible for ensuring the quality of our products and services, and for implementing processes and procedures to improve our quality management system.Key ResponsibilitiesQuality Inspection...
-
Quality Assurance Specialist
3 weeks ago
Philadelphia, Pennsylvania, United States Jobot Full timeJob SummaryWe are seeking a highly skilled Quality Assurance Specialist to join our team at Jobot. As a Quality Assurance Specialist, you will be responsible for investigating and resolving non-conformances and customer complaints in a timely and efficient manner.Key ResponsibilitiesCollaborate with cross-functional teams to initiate, investigate, document,...
-
Clinical Quality Management Data Specialist
3 weeks ago
Philadelphia, Pennsylvania, United States PHMC Full timeJob OverviewPHMC is a leader in public health, and we are committed to providing high-quality services to our community. As a Clinical Quality Management Data Specialist, you will play a critical role in ensuring the accuracy and reliability of data related to HIV care and prevention services in the Philadelphia EMA.ResponsibilitiesConduct Regular Site...
-
Quality Assurance Specialist
7 days ago
Philadelphia, Pennsylvania, United States Beacon Hill Full timeQuality Assurance AssociateWe are seeking a highly skilled Quality Assurance Associate to join our team at Beacon Hill. As a Quality Assurance Associate, you will play a critical role in ensuring the quality of our services and supporting the growth and development of our agents.Key Responsibilities:Coach and train other agents by analyzing data, processes,...
-
Quality Assurance Specialist
2 weeks ago
Philadelphia, Pennsylvania, United States System Soft Technologies Full timeJob Summary:System Soft Technologies is seeking a highly skilled Quality Assurance Specialist to join our team. As a Quality Assurance Specialist, you will play a critical role in ensuring the quality of our software applications through the entire software lifecycle.Key Responsibilities:Test Planning and Execution: Develop and execute test plans, test...