Medical Staff Credentialing Auditor - Payer Enrollment

Inova Health System
parental leave, paid time off, remote work
United States, Virginia, Fairfax
8095 Innovation Park Drive (Show on map)
Mar 28, 2025
Inova Center for Personalized Health is looking for a dedicated Medical Staff Credentialing Auditor-Payer Enrollment to join the team. This role will be full-time day shift from Monday - Friday, 8:00 a.m. - 5:00 p.m. \| Remote Position The Medical Staff Credentialing Auditor assists departmental staff with quality checks of all credentialing functions for all service lines including individual practitioners, facilities, and CVO clients. Responsible for all delegation auditing functions as well as researching, investigating and resolving complex provider credentialing to include annual audits and all related reporting. Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation. Featured Benefits: Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program. Retirement: Inova matches the first 5% of eligible contributions - starting on your first day. Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans. Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost. Work/Life Balance: offering paid time off, paid parental leave, and flexible work schedules Medical Staff Credentialing Auditor-Payer Enrollment Job Responsibilities Alert credentialing staff of any credentialing errors and changes in credentialing policies to ensure files are compliant with all governing standards. Conducts follow-up and research regarding additional information required and documents appropriately. Coordinates high-priority applications to expedite processing. Ensures that delegated audits reach target performance metrics and that they are conducted according to applicable contract terms. Processes initial and re-credentialing applications as assigned by leadership in an efficient and timely manner. Maintains re-credentialing functions to ensure Inova Health System is compliant and within all applicable timelines to maintain delegation agreements. Communicates the status of applications to practitioners and all interested parties on a regular basis. Maintains current knowledge of and ensures compliance with regulatory requirements and accrediting body standards. May perform other duties as assigned. Medical Staff Credentialing Auditor-Payer Enrollment Additional Requirements Experience - 3 years of auditing or quality analysis experience including standard credentialing functions Education - Associate Degree Associate degree (or relevant experience in lieu of degree) Medical Staff Credentialing Auditor-Payer Enrollment Preferred Requirements Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) preferred. Experience in medical staff credentialing, privileging, and payer enrollment credentialing, including auditing functions. In-depth knowledge of payer enrollment processes, including commercial, Medicare, Medicaid, and managed care organizations. Strong understanding of state, federal, and accreditation standards (e.g., CMS, NCQA, Joint Commission, URAC) related to credentialing and enrollment. Proficiency in credentialing software and systems (e.g., CAQH, PECOS, Availity, MD Staff, or similar platforms). Remote Eligibility: This position is eligible for remote work for candidates residing in the following states - VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV