Note: The job is a remote job and is open to candidates in USA. AdventHealth West Florida is a connected health and wellness network dedicated to providing whole-person care. The Credentialing Auditor/Educator ensures accuracy, compliance, and consistency in provider credentialing processes by auditing files and workflows, developing training materials, analyzing data, identifying process gaps, and supporting quality assurance and external audits.
Responsibilities
- Conducts regular audits of credentialing files, systems, and workflows to confirm adherence to regulatory, accreditation, and organizational standards
- Develops and delivers education and training materials for credentialing staff and providers, including policies, procedures, and best practices
- Analyzing data and reports, identifying process gaps, recommending improvements, and collaborating with cross-functional teams such as compliance, quality, and provider relations
- The role also supports ongoing quality assurance activities, participates in internal reviews, and assists in preparing for external surveys or audits
Skills
- Strong knowledge of provider credentialing, privileging, and health care regulatory requirements (e.g., CMS, Joint Commission, NCQA)
- Experience with auditing processes, quality assurance, and compliance monitoring in a health care or managed care environment
- Ability to design and deliver education and training programs, including developing clear policies, procedures, and learning materials
- Proficiency with credentialing software, data analysis tools, and standard office applications (e.g., MS Office, spreadsheets, reporting systems)
- Excellent attention to detail, critical thinking, and problem-solving skills with the ability to interpret complex guidelines and standards
- Strong written and verbal communication skills, including the ability to explain complex information clearly to diverse audiences
- Demonstrated ability to work independently in a remote setting, manage multiple priorities, and meet deadlines
- Relevant experience in medical staff services, provider enrollment, or credentialing
- CPCS or CPMSM certification highly preferred
- Associate or Bachelor's degree in Health Administration, Business, or a related field preferred
- Equivalent experience considered
Benefits
- Full-time employment
- Remote role
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