Credentialing Specialist Delegated Audits, Tulane University Medical Group
Tulane University New Orleans, LA Full-time Health Care Provider
Posted on September 1, 2023
Responsible for timely and accurate completion of all activities and documents related to TUMG’s Delegated Credentialing Contracts, including supporting the auditing of TUMG’s contractual sub-delegate, health plan audits of TUMG as a delegated entity and providing required information to contracted health plans to support their Regulatory Audits. Responsible for maintaining current working knowledge of NCQA Credentialing Requirements and both TUMG and TMC credentialing P&Ps. Able to work in a highly complex environment with TUMG Compliance Officer, TUMG Credentialing & Enrollment manager, and Tulane Medical Center Medical Affairs staff and management, under leadership of the TUMG Director of Contracting, Credentialing, and Enrollment. Works with large volumes of data and confidential documents. Responsible for timely completion and maintenance of external and internal documentation related to TUMG’s compliance with credentialing audit activities. Candidate must have work with team on routine credentialing and enrollment work when not actively working audits.