Site Inspector - Credentialing

Job Summary:

We are seeking a detailoriented and highly organized Site Inspector Credentialing to join our team. The successful candidate will conduct onsite inspections of healthcare facilities to ensure compliance with credentialing standards regulatory requirements and quality benchmarks. This role is integral to maintaining a highquality provider network and ensuring the safety and satisfaction of patients served by the network.

Key Responsibilities:

• Site Inspections and Evaluations:
  • Perform onsite inspections of provider facilities including clinical and administrative areas to assess compliance with company standards state and federal regulations and accreditation requirements (e.g. NCQA).
  • Evaluate physical environments for cleanliness accessibility equipment maintenance and patient safety protocols.
  • Review facility policies procedures and documentation related to patient care infection control and emergency preparedness.
• Credentialing Verification:
  • Confirm licensure certifications and accreditations of healthcare providers and facilities during site visits.
  • Ensure adherence to operational and staffing standards including adequate training and credentialing of clinical staff.
• Reporting and Documentation:
  • Document findings in detailed inspection reports highlighting areas of compliance and deficiencies.
  • Recommend corrective actions and follow up on implementation to ensure compliance.
• Stakeholder Engagement:
  • Act as a liaison between the provider network and the credentialing department to address compliance issues.
  • Educate providers on credentialing standards and assist in improving their readiness for inspections.
  • Conduct interviews with healthcare staff management and providers to gather insights on operations and patient care practices.
  • Analyze staff qualifications and training programs to ensure adherence to best practices in healthcare delivery.
• Quality Assurance and Continuous Improvement:
  • Collaborate with internal teams to improve credentialing processes and provider onboarding.
  • Participate in quality assurance initiatives to enhance overall provider network performance.
• Travel:
  • Travel to provider locations as required for onsite inspections.

Qualifications:

Education and Experience:

• Associates degree in healthcare administration Nursing Public Health or a related field Certified Medical Assistant or Registered Medical Assistant with relevant experience.
• 2 3 years of experience in clinical setting or healthcare operations

Skills and Certifications:

• Understanding of state Medicaid guidelines regulations and policies
• Strong knowledge of healthcare accreditation standards (e.g. NCQA Join Commission
• Familiarity with regulatory requirements including HIPAA and OSHA
• Familiarity with coding practices (ICD 10 CPT coding) is preferred.
• Certification in healthcare credentialing or quality (e.g. CPCS CPHQ CJCP) is preferred.
• Excellent communication and interpersonal skills for provider engagement.
• Proficient in Microsoft Office Suite and credentialing software systems.

Other Requirements:

• Valid drivers license and reliable transportation for travel to provider sites.
• Ability to manage multiple inspections and meet deadlines in a fastpaced environment.