CVO Documentation & Audit Specialist

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Job Overview

The CVO Documentation & Audit Specialist position at Neolytix is a crucial role aimed at facilitating preparation and compliance efforts associated with NCQA CVO Certification. The role is fully remote, with the target start date set for March 1, 2025. This position falls under the Credentialing Operations department and reports directly to the Director of Credentialing or the Vice President of Operations. Neolytix is actively looking for a candidate who can lead documentation and compliance initiatives that are essential for meeting NCQA standards.

Key Responsibilities

The primary responsibilities of the CVO Documentation & Audit Specialist are divided into several significant areas:

NCQA Documentation & Compliance (50%)

• The specialist will be responsible for developing, writing, and maintaining credentialing policies in alignment with NCQA CVO standards.
• A vital aspect involves cross-referencing policies and procedures with specific NCQA standards and elements to ensure compliance.
• Organizing documentation necessary for the Interactive Review Tool (IRT) submission is also critical.
• The candidate will need to track and monitor updates, corrections, and clarifications to NCQA policies.

Quality Improvement & Audit (30%)

• The role includes establishing and maintaining quality improvement processes as mandated by NCQA.
• Conducting internal file audits on closed files (approximately 10-20%) will ensure adherence to compliance standards.
• The candidate will be responsible for preparing mock survey materials and conducting internal readiness assessments, which are preparatory steps for the NCQA survey.
• Collecting and analyzing Quality Improvement metrics and compiling reports for certification review will be part of the requirements.

Survey Preparation & Support (20%)

• Coordinating the timeline and requirements for survey submissions will be essential.
• Preparing file samples for review by the NCQA surveyor is also part of the responsibilities.
• Supporting the logistics of virtual surveys and addressing documentation requests is expected.
• The candidate will also need to address any findings from the surveyors and manage responses with corrective actions.

Required Qualifications

To be considered for the CVO Documentation & Audit Specialist role, candidates must have the following qualifications:

• A minimum of 4-6 years of direct experience in healthcare credentialing or CVO operations.
• Someone with direct expertise in NCQA credentialing standards (CVO or CR) is essential.
• Experience in preparing for or participating in NCQA surveys or similar health plan audits is a must.
• Exceptional skills in policy and procedure writing.
• Proficiency in using credentialing software such as CAQH, VerityStream, Cactus, or comparable systems.
• Strong command of English in both written and verbal forms.

Preferred Qualifications

While not mandatory, the ideal candidate will have:

• A CPCS (Certified Provider Credentialing Specialist) or CPMSM certification from NAMSS.
• Experience with delegated credentialing arrangements is a plus.
• A background working in an NCQA-certified CVO environment can be beneficial.
• Familiarity with JCAHO, CMS, and other state credentialing requirements enhances the candidate's profile.

Salary and Employment Type

The position is a full-time role, but specific salary details are not provided in the job listing. Candidates should inquire about salary expectations during the interview process or application to get a better understanding of compensation associated with this role.

Summary

In summary, the CVO Documentation & Audit Specialist position at Neolytix is geared towards individuals with comprehensive background in credentialing and compliance, particularly as it relates to NCQA standards. With significant responsibilities in documentation, quality improvement processes, and survey preparation, this role is pivotal in ensuring the organization meets its certification timeline. Job seekers interested in this full-time remote opportunity should possess the foundational qualifications and skill sets mentioned above. Being prepared to demonstrate relevant experience and expertise during the application process will be critical for interested candidates.

This job offer was originally published on himalayas.app