Credential Audit Analyst-NCQA, URAC and CMS

Job Summary Under supervision, this role oversees essential credentialing functions to attain and maintain quality providers in the dental network. The role also conducts audits for credentialing and network data quality, understands credentialing policies per NCQA, URAC, and CMS standards, and serves as a liaison to delegated entities and vendors to ensure current credentialing processes are in place. Develop and perform queries for data reporting purposes, including directories, ad hoc reports, and network management reports. Monitor and maintain credentialing and recredentialing policies and programs, as well as state and federal requirements to ensure compliance. Provide operational and industry knowledge to ensure credentialing practices. Required Qualifications Bachelor's degree and 2 years of experience in accreditation programs (e.g., NCQA, URAC, CMS) or 6 years of experience in accreditation programs. Proficiency in accreditation program standards such as NCQA, URAC, CMS. Knowledge of state and federal requirements for contracting and credentialing. Attention to detail and the ability to track information to defined quality standards. Knowledge of documents and contents used in provider contracting, including applications, agreements, fee schedules, and credentialing. Knowledge of provider contracting terms. Analytical and detailed-oriented skills. Experience maintaining detailed complex provider records. Ability to balance multiple priorities while meeting commitments for quality and delivery at agreed schedules. Clear and concise verbal and written communication skills. Proficiency in Microsoft Office products, Excel, email, and Internet. Ability to work well in a team environment. Preferred Qualifications Analytical skills. Knowledge of the dental industry. Base Pay Range: $38,100.00 - $80,000.00 Dearborn Group Employment Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. #J-18808-Ljbffr