Quality Compliance Analyst
TeleSpecialists
Atlanta, GA, USA
Published today
Compliance Management Systems / Technology
Full time
This is an in-office position at our Fort Myers, FL, and Brookhaven, ATL offices.
About Us:
TeleSpecialists is a rapidly growing national telemedicine company seeking the right talent to join our team. We provide emergent and routine neurology and psychiatry services in over 300 hospitals across the country and continuing to expand services. We are seeking the right talent to join our team and help us with our mission of impacting patients, providing timely high-quality care to patients, and transforming the future of healthcare. We have an innovative and entrepreneurial culture that provides the opportunity for personal and professional growth.
Tele Specialists Offers:
• A great culture with a team environment
• A fun, diverse work environment
• A rapidly growing company with career advancement opportunities
• Medical, Dental and Vision benefits
• 401k match
• Paid Vacation
• Leadership Training Classes
• Mentorship Program
• Tuition Reimbursement
Job Summary:
The Quality Compliance Analyst will work closely with our Internal Regulatory Compliance & Quality Control Department. The Quality Compliance Analyst will be responsible for building strong relationships between the Credentialing and Licensing Department and providing training and ongoing audits of process, procedures and workflow instructions. This position plays a key role in identify areas of potential compliance issues, following all regulatory requirements and meeting Joint Commission and NCQA standards. This position requires strong attention to detail, a proactive orientation and strong communication with each department within TeleSpecialists to ensure workflow instructions are followed by credentialing and licensing to strive for quality and compliance of the processing of provider files.
Duties/Responsibilities:
• Develops relationship and establishes strong lines of communication with the licensing and credentialing team members and all TS Departments.
• Identify key elements within Facilities By-Laws and track in credentialing system
• Delegated Credentialing - Track and assisting with contract edits and retention, credentialing forms, checklists, and facility communication on requirements.
• Assists Credentialing/Licensing in review and oversight of expirable documentation required for state licensure or credentialing privileges.
• Serves as the primary communication for credentialing & licensing tracking of MedMal claims on providers for current updates to allow for accurate disclosures on applications. (Any/All cases including but not limited to TeleSpecialists).
• Resignations - Collect provider resignation statements to present to the weekly credentials committee meeting.
• Assists physician/facilities with requests of Case Logs and accuracy of Logs to meet credentialing criteria
• Conduct regular audits of credentialing files to ensure ongoing compliance with internal and external standards
• Maintains a documented process of Quality Audits of files by each division in credentialing and licensing for reporting, trending, and continued education purposes QC Inbox - Maintain and correspond to all communication in QC inbox. TAT - email response is within 24 hours.
• Develops a working knowledge of licensing and credentialing policies and procedures.
• Delegated Credentialing - Track and assisting with contract edits and retention, credentialing forms, checklists, and facility communication
• Works with department managers to develop, implement and update policies and procedures and ensure they meet both TJC and NCQA accreditation standards.
• Monitor changes in regulatory requirements and update credentialing processes accordingly.
• Ensure compliance with NCQA and TJC or Joint Commission accreditation standards and surveys, preparing for and participating in accreditation inspections.
• Other duties as assigned
Education/Experience:
• Bachelor's degree in healthcare administration, business administration, or a related field is preferred.
• Minimum of 5 years of experience in medical staff credentialing and privileging.
• In-depth knowledge of NCQA and TJC or Joint Commission accreditation standards and survey processes.
• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification is highly desirable.
• Strong organizational and managerial skills with the ability to handle multiple tasks and deadlines.
• Excellent communication and interpersonal skills, with the ability to work collaboratively with diverse teams and stakeholders.
• Detail-oriented with a commitment to accuracy and compliance.
• Proficient in using credentialing software and other relevant computer applications.
About Us:
TeleSpecialists is a rapidly growing national telemedicine company seeking the right talent to join our team. We provide emergent and routine neurology and psychiatry services in over 300 hospitals across the country and continuing to expand services. We are seeking the right talent to join our team and help us with our mission of impacting patients, providing timely high-quality care to patients, and transforming the future of healthcare. We have an innovative and entrepreneurial culture that provides the opportunity for personal and professional growth.
Tele Specialists Offers:
• A great culture with a team environment
• A fun, diverse work environment
• A rapidly growing company with career advancement opportunities
• Medical, Dental and Vision benefits
• 401k match
• Paid Vacation
• Leadership Training Classes
• Mentorship Program
• Tuition Reimbursement
Job Summary:
The Quality Compliance Analyst will work closely with our Internal Regulatory Compliance & Quality Control Department. The Quality Compliance Analyst will be responsible for building strong relationships between the Credentialing and Licensing Department and providing training and ongoing audits of process, procedures and workflow instructions. This position plays a key role in identify areas of potential compliance issues, following all regulatory requirements and meeting Joint Commission and NCQA standards. This position requires strong attention to detail, a proactive orientation and strong communication with each department within TeleSpecialists to ensure workflow instructions are followed by credentialing and licensing to strive for quality and compliance of the processing of provider files.
Duties/Responsibilities:
• Develops relationship and establishes strong lines of communication with the licensing and credentialing team members and all TS Departments.
• Identify key elements within Facilities By-Laws and track in credentialing system
• Delegated Credentialing - Track and assisting with contract edits and retention, credentialing forms, checklists, and facility communication on requirements.
• Assists Credentialing/Licensing in review and oversight of expirable documentation required for state licensure or credentialing privileges.
• Serves as the primary communication for credentialing & licensing tracking of MedMal claims on providers for current updates to allow for accurate disclosures on applications. (Any/All cases including but not limited to TeleSpecialists).
• Resignations - Collect provider resignation statements to present to the weekly credentials committee meeting.
• Assists physician/facilities with requests of Case Logs and accuracy of Logs to meet credentialing criteria
• Conduct regular audits of credentialing files to ensure ongoing compliance with internal and external standards
• Maintains a documented process of Quality Audits of files by each division in credentialing and licensing for reporting, trending, and continued education purposes QC Inbox - Maintain and correspond to all communication in QC inbox. TAT - email response is within 24 hours.
• Develops a working knowledge of licensing and credentialing policies and procedures.
• Delegated Credentialing - Track and assisting with contract edits and retention, credentialing forms, checklists, and facility communication
• Works with department managers to develop, implement and update policies and procedures and ensure they meet both TJC and NCQA accreditation standards.
• Monitor changes in regulatory requirements and update credentialing processes accordingly.
• Ensure compliance with NCQA and TJC or Joint Commission accreditation standards and surveys, preparing for and participating in accreditation inspections.
• Other duties as assigned
Education/Experience:
• Bachelor's degree in healthcare administration, business administration, or a related field is preferred.
• Minimum of 5 years of experience in medical staff credentialing and privileging.
• In-depth knowledge of NCQA and TJC or Joint Commission accreditation standards and survey processes.
• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification is highly desirable.
• Strong organizational and managerial skills with the ability to handle multiple tasks and deadlines.
• Excellent communication and interpersonal skills, with the ability to work collaboratively with diverse teams and stakeholders.
• Detail-oriented with a commitment to accuracy and compliance.
• Proficient in using credentialing software and other relevant computer applications.