Credentialing and CVO Documentation Specialist
Remote
Full Time
Experienced
Position Title: CVO Documentation & Audit Specialist
Department: Credentialing Operations
Reports To: Director of Credentialing / VP of Operations
Location: Remote — Philippines
Employment Type: Full-time
Target Start Date: March 1, 2025
Position Summary
The CVO Documentation & Audit Specialist will lead the preparation, documentation, and compliance efforts required for NCQA CVO Certification. This is a critical hire for an accelerated certification timeline targeting Q3 2025. The role involves developing and maintaining credentialing policies and procedures aligned with NCQA standards, conducting internal audits, preparing documentation for survey submission, and ensuring ongoing compliance with certification requirements.
Key Responsibilities
- NCQA Documentation & Compliance (50%)
- Develop, write, and maintain credentialing policies and procedures aligned with NCQA CVO standards
- Cross-reference all policies and procedures to specific NCQA standards and elements
- Prepare and organize documentation for Interactive Review Tool (IRT) submission
- Track and monitor NCQA policy updates, corrections, and clarifications
- Quality Improvement & Audit (30%)
- Establish and maintain quality improvement (QI) processes as required by NCQA
- Conduct internal file audits (10-20% of closed files) to ensure compliance
- Prepare mock survey materials and conduct internal readiness assessments
- Collect and analyze QI metrics and prepare reports for certification review
- Survey Preparation & Support (20%)
- Coordinate survey submission timeline and requirements
- Prepare file samples for NCQA surveyor review
- Support virtual survey logistics and documentation requests
- Address surveyor findings and coordinate corrective action responses
Required Qualifications
- 4-6 years of experience in healthcare credentialing or CVO operations
- Direct experience with NCQA credentialing standards (CVO or CR) — REQUIRED
- Experience preparing for and/or participating in NCQA surveys or health plan audits
- Strong policy and procedure writing skills
- Proficiency with credentialing software (CAQH, VerityStream, Cactus, or similar)
- Excellent English written and verbal communication
Preferred Qualifications
- CPCS (Certified Provider Credentialing Specialist) or CPMSM certification from NAMSS
- Experience with delegated credentialing arrangements
- Prior work at an NCQA-certified CVO
- Familiarity with JCAHO, CMS, and state credentialing requirements
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