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Manager of Credentialing Audits and NCQA Standards

Tulane University
New Orleans, LA
Manager of Credentialing Audits and NCQA StandardsTUMG Contracting

Location: New Orleans, LA


The Tulane University Medical Group (TUMG) Manager of Credentialing Audits and NCQA Standards reports directly to the CEO. This position is responsible for all credentialing and re-credentialing audits with managed care organizations, sub-delegated hospital partners, credentialing vendors, and government payers in delegated contracts. The Manager will be the responsible for keeping current on all NCQA standards preparing policies and procedures regarding these standards.
The position is responsible for working with the Tulane University Government Relations team to help advocate on behalf of TUMG regarding healthcare issues as needed at local, state, and federal levels. This position functions as an internal resource to advocate on statutory and regulatory issues that impact healthcare operations and billing at TUMG.

Required Qualifications

•Bachelor’s Degree in business or related field.•Five plus (5+) years’ healthcare experience in credentialing and NCQA.

Preferred Qualifications

•Academic Medical group experience or other healthcare related experience.•Personally audited credentialing files to create both summary and comprehensive reports.

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