Site Inspector - Credentialing; Part-Time

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.

• 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.

• 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, Joint 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.