Quality Assurance Specialist - Credentialing

Job Summary

A company is looking for a Quality Assurance Specialist - Credentialing.

Key Responsibilities

• Conduct comprehensive credentialing file audits and quality reviews to ensure compliance with TJC and NCQA standards
• Oversee delegated credentialing arrangements and manage payer credentialing audits
• Track and report credentialing quality metrics, identifying risks and opportunities for improvement

Required Qualifications

• Bachelor's degree preferred or equivalent work experience
• 3+ years of experience in credentialing, quality assurance, compliance, or healthcare operations
• Strong knowledge of TJC and NCQA credentialing and accreditation standards
• Experience conducting credentialing audits and managing corrective action plans
• Familiarity with accreditation survey processes and strong analytical skills