Credentialing Audit Specialist, MedPOINT Management (MPM)

Posted on September 18th, 2025

Salary Range: $22 - $27/ hr
 

Summary:
Responsible for assisting with tasks to ensure that all files and processes are in accordance with NCQA (and other regulatory agency) credentialing standards and regulations. Assists Lead Credentialing Auditor prepares documents timely for onsite and virtual audits.
 

Duties and Responsibilities:
• Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
• Conducts research on updated regulatory and health plan policies as directed by team leadership.
• Responsible all preparation including locating and verifying requested documents, submitting selection rosters and preparing CAPs as applicable for HICE, DMHC, DHCS and health plan audits as requested by Lead Credentialing Auditor and/or Compliance officer.
• Attend exit audit interviews with health plans and handle follow up requests timely.
• Ensure audit documents are submitted timely and accurately.
• Monitors system controls and updates quarterly reporting for submission to health plans.
• Responds to inquiries from health plans and provider offices/clinics; interfaces with internal and external customers on day-to-day credentialing issues as they arise.
• Optimizes efficiency with document generation and reporting.
• Coordinates primary source verification process with Gemini Diversified Services (CVO)
• Enters primary source documentation in home grown credentialing database
• Participates in credentialing committee meetings (monthly and ad hoc)
• Attend compliance huddles to update on credentialing audit related items
• Works collaboratively with credentialing team to ensure that files are complete and up-to-date
• Performs miscellaneous job-related duties as assigned and requested

Minimum Job Requirements:
• High School Diploma or GED
• Minimum of one year experience with hospital medical staff, health plan or managed care credentialing experience
• NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) or actively pursuing the above certification highly preferred.
• Proficiency with Microsoft Office Programs; primarily Work and Excel 2013 and higher
• Knowledge of medical credentialing and privileging procedures and standards
• EZ-CAP®, Gemini G1 and symplr knowledge a plus.
 

Knowledge, Skills and Abilities Required:
• Strong written and oral communication skills.
• Excellent presentation and analytical skills.
• Ability to analyze, interpret and prepare reports.
• Ability to multitask in busy environment

Interested candidates can send you resumes to nkhan@medpointmanagement.com or apply on their website -   HDO Credentialing Audit Specialist - MedPOINT Management

HDO Credentialing Coordinator, MedPOINT Management

Posted on September 18th, 2025

Salary Range: $28-$31/ hr
Summary
Responsible for collaborating with CVO, credentialing TMs and provider network operation contracting team to coordinate, monitor and maintain the credentialing and re-credentialing process for Health Delivery Organizations (HDOs).

Duties and Responsibilities

• Coordinates all activities related to network HDO credentialing including, but not limited to application completeness and maintenance for HDOs.
• Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
• Ensures that all facilities meet standards related to quality improvement programs and personnel issues.
• Verifies that providers are accredited by an appropriate accrediting agency before submission for HDO credentialing and recredentialing processes.
• Oversees preparation of HDO credentialing/recredentialing files for completion and presentation to MedPOINT’s (MPM) Credentialing Committee.
• Responds to inquiries from health plans and potential HDO locations; interfaces with internal and external customers on day-to-day credentialing issues as they arise.
• Optimizes efficiencies with document generation and reporting.
• Establish Health Delivery Organization (HDO) material timelines and ensure that proper documents are received.
• Participates in MPM credentialing committee meetings (monthly and ad hoc).
• Collects and verifies quarterly provider rosters from HDOS.
• Assists with P & P development in accordance with NCQA guidelines for HDO credentialing.
• Contributes information to any corrective action plans related to HDOs.
• Assists with non-HDO credentialing functions as requested by leadership as time permits.
• Performs miscellaneous job-related duties as assigned and requested.
• Adhere to MedPOINT Management’s core values: Accountability, Community, Celebration, Integrity, Innovation & Collaboration.

Minimum Job Requirements

• High School Diploma or GED.
• Minimum of one year experience with hospital medical staff, health plan or managed care credentialing experience including HDO processing.
• NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) or actively pursuing one of these certifications highly preferred.
• Proficiency with Microsoft Office products, primarily Work and Excel 2013 or higher.
• Knowledge of all aspects of credentialing including HDO Credentialing.
• EZ-CAP, Gemini GI and/or symplr a plus.

Skill and Abilities

• Excellent presentation and analytical skills.
• Strong written and verbal communication skills.
• Ability to analyze, interpret and prepare reports.
• Ability to multitask in very busy environment.

Interested candidates can send you resumes to nkhan@medpointmanagement.com or apply on their website - HDO Credentialing Coordinator - MedPOINT Management