Credentialing File Auditor

Job Description

UW Medicines programs encompass advanced medical diagnostics treatment services and clinical support for educating medical students as well as postgraduate trainees. Additionally UW Medicine maintains one of the largest university-based research programs in the U.S. and provides care to underserved and disadvantaged populations supporting the economic vitality of UW Medicines health system.

Medical Staff Affairs is mission critical to UW Medicine which generates over $4B per year in revenue. Medical staff at Harborview Medical Center UW Medical Center(s) and Fred Hutchinson Cancer Center cannot work unless they are properly credentialed and privileged in a timely fashion. Credentialing and privileging records are audited regularly by the Department of Health (DOH) The Joint Commission (TJC) and other external regulatory and accreditation agencies.

Under the general guidance of the Senior Manager of Credentialing Quality & Compliance the Credentialing File Auditor audits medical staff credentialing and privileging files for UW Medicine which includes UW Medical Center(s) Harborview Medical Center Fred Hutchinson Cancer Center UW Medicine Primary Care Clinics and UW Husky Health.

The Credentialing Auditor is responsible for conducting comprehensive audits of credentialing and privileging processes to ensure compliance with internal policies accreditation standards and regulatory requirements. This role involves the review and evaluation of credentialing files for completeness accuracy and adherence to established guidelines and regulatory requirements. The auditor will collaborate with department leadership to identify and recommend corrective actions process improvements and training opportunities.

DUTIES AND RESPONSIBILITIES

Credentialing Files Audit: 70%

• Conduct detailed audits of credentialing and privileging files submitted by the credentialing staff to verify the accuracy of information and compliance with organizational accreditation and regulatory standards (e.g. The Joint Commission NCQA CMS etc.). Perform follow-up reviews to ensure identified issues are resolved and improvements are sustained.
• Ensure credentialing activities meet regulatory requirements including primary source verifications licensure certifications and malpractice history.
• Stay up to date with changes in laws regulations and standards affecting credentialing and ensure the organization remains compliant with these changes.
• Assist in developing and providing training to credentialing staff on updated policies procedures and best practices related to credentialing and auditing.
• Partner with various departments including compliance quality assurance and medical staff services to ensure consistency and alignment in credentialing practices.
• Ensure all credential documentation is properly stored easily retrievable and kept confidential as required by law.

Reporting Process Improvement and Quality Assurance 20%

• Document audit results to inform key performance metrics for the Medical Staff Affairs Productivity Dashboard.
• Identify any gaps in documentation or evaluation processes and work with relevant teams to implement corrective actions as needed.
• Share file review revisions and/or areas of concern to the Credentialing Manager.
• Provide recommendations for corrective action where necessary.
• Provide regular updates to the Senior Manager Associate Director and Director on quality of files and team performance.
• Identify trends in errors or non-compliance and suggest process improvements to enhance the quality of credentialing functions.
• Work closely with the credentialing team to implement these improvements.
• Analyze credentialing data and audit results to provide leadership with insights into trends risks and areas for improvement.

Other duties as assigned: 10%

• Medical Staff Affairs is a collaborative unit with a focus on teamwork. During periods of peak hiring seasons file auditors may be asked to help with credentialing and privileging and various other projects as assigned by the Manager Associate Director or Director.

MINIMUM REQUIREMENTS

• Bachelors degree in health administration business administration or a related field is required.
• Minimum of 3 years of experience in credentialing healthcare compliance or medical staff services.
• Knowledge of credentialing standards and regulations (e.g. TJC NCQA URAC).
• CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional Medical Services Management) preferred or willingness to obtain within 2 years of hire date.
• Strong attention to detail and analytical skills.
• Time management and efficiency.
• Excellent written and verbal communication skills.
• Proficiency in credentialing software systems (e.g. MSOW and MD Staff) and Microsoft Office Suite.
• Ability to work independently and manage multiple priorities.

Equivalent experience may substitute for degree requirements.

DESIRED QUALIFICATIONS

• Experience in an auditing or quality assurance role is preferred.

Work Environment:

Standard office environment.

Compensation Benefits and Position Details

Pay Range Minimum:

Pay Range Maximum:

Other Compensation:

Benefits:

Temporary or Regular

FTE (Full-Time Equivalent):

Union/Bargaining Unit:

About the UW

Working at the University of Washington provides a unique opportunity to change lives on our campuses in our state and around the world.

UW employees bring their boundless energy creative problem-solving skills and dedication to building stronger minds and a healthier return they enjoy outstanding benefits opportunities for professional growth and the chance to work in an environment known for its diversity intellectual excitement artistic pursuits and natural beauty.

Our Commitment

The University of Washington is committed to fostering an inclusive respectful and welcoming community for all. As an equal opportunity employer the University considers applicants for employment without regard to race color creed religion national origin citizenship sex pregnancy age marital status sexual orientation gender identity or expression genetic information disability or veteran status consistent with UW Executive Order No. 81.

To request disability accommodation in the application process contact the Disability Services Office at or .

Applicants considered for this position will be required to disclose if they are the subject of any substantiated findings or current investigations related to sexual misconduct at their current employment and past employment. Disclosure is required under Washington state law.