Credentialing Auditor

Job Category:  Administrative, HR, Business Professionals
Department:  Credentialing (360)
Location: 

Los Angeles HQ, California, US

Position Type:  Full Time
Requisition ID:  1481

 

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

DUTIES

The Credentialing Auditor ensures compliance of the Plan Partners (PPs) and/or Participating Physician Groups (PPGs) maintain regulatory, contractual and L.A. Care requirements. The Credentialing Auditor is responsible for performing annual and focused audits and continuous monitoring activities. This position also acts as a liaison between the PPs and/or PPGs and L.A. Care regarding credentialing issues. This position will develop standardized reports, independent analysis of audit results, credentialing data and activities; reports will be submitted to the Chief of Operations, Credentialing Subcommittee, Quality Management Committee, and Board of Governors. This position is responsible for interacting and coaching activities to improve overall compliance with PPs, PPGs, internal and external parties, upper management, and vendors in order to facilitate solutions and promote credentialing agendas. The Credentialing Auditor will assist with the development of policies and procedures within the department. 

QUALIFICATIONS AND REQUIREMENTS

EDUCATION

Required:

High School Diploma

Preferred:

Associate's Degree

LICENSES/CERTIFICATIONS

Preferred:

Provider Credentialing Specialist (CPCS)

EXPERIENCE

Required:

With High School Diploma: At least 4-5 years of credentialing experience in managed care or hospital.

Preferred:

With Associate's Degree: At least 3-4 years of credentialing experience in managed care or hospital. 

L.A. Care offers a wide range of benefits including

  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)


Job Segment: Audit, Medical, Finance, Healthcare