RI International · 1 day ago
Credentialing Auditor
United States
Full-time
Remote
Entry Level
$23/hr - $25/hr
1+ years expRI International is dedicated to empowering individuals on their journey to recovery through innovative healthcare solutions. The Credentialing Auditor will support the credentialing and enrollment processes by conducting audits, ensuring compliance, and maintaining accurate provider records.
ConsultingHealth CareManagement ConsultingTraining
Responsibilities
Audit credentialing documentation within the system to confirm accuracy, compliance, and completeness
Review Modio data migration and system integration records from NTST to ensure no discrepancies or gaps
Verify that provider files are properly linked and updated across platforms
Identify and report missing provider enrollments in payer systems
Track and document enrollment progress, escalating delays as needed
Assist Credentialing Specialist III with resolving enrollment discrepancies between internal and external systems
Assist with uploading credentialing and enrollment documentation into the system
Ensure that required documentation (licenses, certifications, training records, etc.) is collected and stored accurately
Support the collection of outstanding provider documents by communicating with staff and leadership
Audit files for compliance with federal, state, and organizational standards
Ensure documentation is consistent with payer requirements and credentialing standards
Flag incomplete, upcoming expired, or expired documentation for follow-up and resolution
Generate routine and ad hoc reports on credentialing and enrollment status
Provide summaries highlighting audit findings, outstanding items, and compliance risks
Support leadership with data for regulatory or internal reviews
Performs other related duties as assigned
Qualification
Required
High school diploma or equivalent
Minimum of one (1) years of health care auditing experience
Strong attention to detail, organizational skills, and ability to meet deadlines
Proficiency with Microsoft Office Suite (Excel, Word, Outlook)
Excellent communication skills for collaborating across departments
Detail-oriented and thorough in auditing and recordkeeping
Ability to learn credentialing and enrollment processes quickly
Strong problem-solving and critical thinking skills
Team player with a proactive and collaborative approach
Commitment to maintaining confidentiality and compliance
If driving is required for this position, must meet all requirements outlined in Recovery Innovations driving policy
If not qualified to drive per driving policy, a Non-Driver Attestation form must be signed
Travel required based on business need
Must be at least 18 years old unless residing in a state where funder or government regulations set a different minimum age requirement
Ability to maintain a high level of confidentiality (HIPAA guidelines and regulations) and professionalism
Must be able to pass a seven-year background check
Must be able to pass substance abuse testing and/or tuberculous testing (if applicable)
Must be able to obtain designated fingerprinting clearance in applicable states
Must be able to pass education verification check
Must be able to pass three-year motor vehicle report and meet minimum eligibility requirements criteria of insurance carrier (if driving is required for this position)
Preferred
Minimum of one (1) years of credentialing experience preferred
Experience with credentialing software or databases preferred
Benefits
Competitive health, dental, and vision insurance
Access to mental health resources and wellness programs
Strong retirement plan with company matching
Generous paid time off to support work-life balance
Ongoing opportunities for professional development and training
Company
RI International
With more than 51 programs across the U.S. and abroad, RI specializes in Crisis, Health, Recovery and Consulting Services.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
David Covington
CEO & President
Paul Galdys
Deputy CEO
Recent News
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