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Credentialing Quality Control Specialist
Credentialing Quality Control SpecialistMVP Health Care • Rochester, NY, United States
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Credentialing Quality Control Specialist

Credentialing Quality Control Specialist

MVP Health Care • Rochester, NY, United States
[job_card.30_days_ago]
[job_preview.job_type]
  • [job_card.full_time]
[job_card.job_description]

At MVP Health Care, we're dedicated to forging a healthier future for everyone, driven by innovative thinking and a commitment to continuous improvement. If you're passionate about health equity, strategic engagement, and making a positive impact in your community, we invite you to become part of #TeamMVP.

What we offer :

  • Opportunities for career growth and advancement
  • A collaborative, people-centric culture that values diverse perspectives and experiences
  • Competitive salary and comprehensive benefits focused on employee well-being
  • The chance to shape the future of healthcare with a team recognized as one of the Best Places to Work For in the NY Capital District and an Inclusive Workplace .

Qualifications you should have :

  • Associate's or Bachelor's degree in a relevant field (e.g., healthcare administration, business, or HR) preferred.
  • At least 2 years of experience in credentialing, compliance, or quality assurance.
  • Experience in healthcare or insurance credentialing is desirable.
  • Strong attention to detail and analytical skills.
  • Familiarity with credentialing software and databases.
  • Knowledge of regulatory standards (e.g., NCQA, URAC, Joint Commission) is advantageous.
  • Excellent communication and organizational skills.
  • Able to work both independently and collaboratively in a fast-paced setting.
  • Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
  • Understanding of data privacy and confidentiality standards.
  • A curiosity to foster innovation and drive growth.
  • A team-oriented mindset and humility.
  • A commitment to making a difference for our customers in every interaction.
  • Your key responsibilities will include :

  • Conducting comprehensive quality control reviews of credentialing and recredentialing files.
  • Verifying credentials, licenses, certifications, and other necessary documentation for accuracy and compliance.
  • Collaborating with credentialing specialists to address discrepancies and ensure timely updates.
  • Maintaining detailed records of QC findings and corrective actions.
  • Assisting in the development and refinement of QC procedures and checklists.
  • Monitoring compliance with internal policies, accreditation standards, and regulatory requirements.
  • Providing feedback and training to credentialing staff on quality standards and best practices.
  • Supporting audits and reporting requirements related to credentialing activities.
  • Staying current with industry standards, regulations, and credentialing best practices.
  • Contributing to a culture of excellence by performing various responsibilities that align with our goal of enhancing healthcare delivery.
  • Work environment :

    This position is virtual within NYS.

    Pay Transparency :

    MVP Health Care is committed to offering competitive compensation and benefits. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP follows pay transparency nondiscrimination principles. Specific compensation will depend on a variety of factors, including geographic location, relevant experience, education, and training.

    Diversity and Inclusion :

    At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. We strive to create an environment where individuals from diverse backgrounds can thrive. MVP is an equal opportunity employer and promotes diversity without discrimination based on various legally protected classifications.

    In support of a safe, drug-free workplace, pre-employment background checks and drug testing are part of our hiring process. If you need accommodations during the application process due to a disability, please reach out to our Talent team.

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