Site Inspector - Credentialing (Part-Time)
Summary:
Position Summary:
We are seeking a detail-oriented and highly organized Site Inspector - Credentialing - to join our team. The successful candidate will conduct on-site inspections of healthcare facilities to ensure compliance with credentialing standards, regulatory requirements, and quality benchmarks. This role is integral to maintaining a high-quality provider network and ensuring the safety and satisfaction of patients served by the network.
Key Responsibilities
- Site Inspections and Evaluations:
- Perform on-site 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 on-site inspections.
Qualifications
Education and Experience:
- Associate's degree in Healthcare Administration, Social Work, 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 driver's license and reliable transportation for travel to provider sites.
- Ability to manage multiple inspections and meet deadlines in a fast-paced environment.
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Professional Management Enterprises
Dec 20, 2025