Openings For Provider Credentialing Auditor

Responsibilities & Duties:

• Conducting a retrospective audit credential audit) internally to evaluate the service reported was

consistent with guidelines and SOPs. Prospective audit should be conducted based on the results of

retrospective audit.

• Conducting focus audit by project, by employees and by issues every week with appropriate check list

(Focus audit can be based on Customer complaints, denials, and request by management).

• Should share the summary of audit report to management on every week which should comprise the

following details such as:

• Type of audit (by project or by employee or by management request)
• Assigned application and follow up audits should be complete on timely manner (TAT 24 hours).
• Verifying the provider/group information & documents like paper application, LOI (Letter of intent)

and Roster.

• Issues identified & Root cause of the issue;
• Recommendation about corrective action plan
• Plan for additional follow-up until the issue gets resolved.
• Fulfills all compliance responsibilities related to the position, handles all protected health information in a

manner consistent with HIPAA regulations.

If Interested kindly share your CV to skamalapathi@health.saisystems.com

Contact Person: P SAIKRISHNA

Contact Number : 93420 77692