Responsibilities
- Review BCBA and related provider packets for completeness, accuracy, and primary source verification.
- Conduct routine and ad hoc audits of delegated credentialing files to ensure compliance (organizational, payer, NCQA/CMS).
- Monitor delegated entities for contractual adherence (turnaround times, documentation, verification).
- Maintain audit tools, checklists, and reporting dashboards.
- Collaborate with the Credentialing team for policy alignment.
- Support pre-delegation and annual delegation audits, including documentation.
- Ensure policies reflect current regulatory/accreditation standards.
- Assist with training for internal staff and delegated entities on credentialing requirements.
- Participate in quality improvement and process optimization efforts.
- Provide comprehensive support for licensure initiatives and facilitate the expansion into new states and payer networks.
Requirements
- Review BCBA and related provider packets for completeness, accuracy, and primary source verification.
- Conduct routine and ad hoc audits of delegated credentialing files to ensure compliance (organizational, payer, NCQA/CMS).
- Monitor delegated entities for contractual adherence (turnaround times, documentation, verification).
- Maintain audit tools, checklists, and reporting dashboards.
- Collaborate with the Credentialing team for policy alignment.
- Support pre-delegation and annual delegation audits, including documentation.
- Ensure policies reflect current regulatory/accreditation standards.
- Assist with training for internal staff and delegated entities on credentialing requirements.
- Participate in quality improvement and process optimization efforts.
- Provide comprehensive support for licensure initiatives and facilitate the expansion into new states and payer networks.
Benefits
- W2 Employee
- Full-Time
- 100% Remote Job
- $72,000- $84,000 annual
- Fully remote – work from anywhere in the U.S.
- Flexible hours with an async-friendly team culture
Work Arrangement
Remote (Worldwide) — Remote, Anywhere in the US
Additional Information
- Flexible hours
- Async-friendly team culture
