QA Coordinator

This is a fully remote position, open to applicants in United States.

📋 Description

• Ensure the integrity, accuracy, and compliance of assigned credentialing processes.

• Collaborate closely with the Senior Manager to develop, prepare, and implement training materials.

• Work in partnership with the Enrollment Submission team to handle Medicaid, MCO, and commercial payer applications.

• Team up with leadership and Contracting to promote licensure expansion and facilitate network growth into new markets.

⛳️ Requirements

• Assess BCBA and related provider packets for completeness, accuracy, and primary source verification.

• Perform routine and ad hoc audits of delegated credentialing files to ensure compliance with organizational, payer, and NCQA/CMS standards.

• Monitor delegated entities for adherence to contractual obligations, including turnaround times, documentation, and verification processes.

• Maintain audit tools, checklists, and reporting dashboards for effective oversight.

• Work alongside the Credentialing team to ensure policy alignment.

• Assist with pre-delegation and annual delegation audits, including necessary documentation.

• Ensure that policies align with current regulatory and accreditation standards.

• Provide training to internal staff and delegated entities regarding credentialing requirements.

• Engage in quality improvement and process optimization initiatives.

• Offer comprehensive support for licensure initiatives and aid in the expansion into new states and payer networks.

🏝️ Benefits

• Fully remote – work from anywhere in the U.S.

• Flexible hours with an async-friendly team culture.