Provider Enrollment Certification Auditor/Documentation Specialist

Contribute to the strategic direction of the business and support impactful mission outcomes as a Provider Enrollment Certification Auditor/Documentation Specialist at GDIT. You will bring your documentation management, process improvement, and healthcare operations expertise to GDIT.

Responsibilities:

• Create new and revise existing Desk Procedures (DPs), Policy Interpretations, Operations Manuals, and supporting documentation.
• Analyze business rule changes, policy updates, system enhancements, and operational process changes to determine documentation impacts.
• Review Functional Modification Requests (FMRs) submitted by customers and business stakeholders to identify required documentation updates.
• Collaborate with operational teams, business owners, leadership, and subject matter experts to gather information necessary for document development.
• Ensure all documentation is clear, concise, standardized, and follows established formatting and version control requirements.
• Maintain document inventories and repositories to ensure the most current versions are accessible to staff.
• Conduct routine audits of existing documentation to identify outdated processes, conflicting instructions, or areas requiring clarification.
• Track document revisions and maintain records of updates, approvals, and implementation dates.
• Review policy changes and regulatory requirements to assess operational impact.
• Meet with leadership to discuss proposed policy updates and required procedural modifications.
• Translate complex policy language into operational procedures and staff guidance.
• Ensure all documentation remains aligned with NC DHHS, NCQA, and organizational requirements.
• Provide recommendations for operational process improvements based on policy and regulatory changes.
• Serve as the primary departmental resource for locating and interpreting business rules, operational requirements, and procedural guidance documented within Desk Procedures and Operations Manuals.
• Respond to staff and leadership inquiries regarding documented processes and operational requirements.
• Provide guidance and clarification regarding procedure interpretation and policy application.
• Assist departments with identifying existing documentation before creating new processes.
• Create provider profiles for credentialing committee review.
• Review provider files and supporting documentation to ensure profile accuracy, completeness, and compliance with credentialing requirements.
• Analyze credentialing information and summarize findings for committee consideration.
• Perform quality reviews of provider profiles prior to committee presentation.
• Redact confidential, protected, or sensitive information in accordance with organizational policies and privacy requirements.
• Ensure provider profiles accurately reflect credentialing findings and required committee actions.
• Participate in daily provider profile review meetings with credentialing staff and leadership.
• Present provider profile content and address questions during review sessions.
• Collaborate with credentialing leadership to resolve profile discrepancies and documentation concerns.
• Prepare provider profiles for final presentation to the Credentialing Committee.
• Attend weekly Credentialing Committee meetings to provide documentation support and answer questions related to provider profiles, credentialing findings, and committee recommendations.
• Document committee feedback requiring profile updates or process improvements.
• Serve as backup to the Credentialing Committee Coordinator as needed.
• Assist with meeting preparation, agenda compilation, and committee materials.
• Support meeting scheduling and participant communications.
• Coordinate committee documentation, reports, and meeting packets.
• Assist with meeting minute preparation and distribution.
• Ensure committee records are maintained according to organizational and regulatory requirements.
• Support NCQA, CVO, and organizational quality initiatives.
• Update documentation to reflect accreditation standards, audit findings, corrective actions, and process improvements.
• Assist with preparation for accreditation surveys, audits, and compliance reviews.
• Participate in process improvement projects that impact departmental procedures and workflows.
• Collaborate with quality management and operational leadership to implement documentation-related corrective actions.
• Partner with Operations, Credentialing, Compliance, Quality, Information Technology, and Leadership teams to ensure documentation reflects current business practices.
• Participate in departmental meetings, workgroups, and project discussions related to operational changes.
• Support implementation activities by communicating documentation changes and providing education to impacted staff.
• Assist with training initiatives by developing procedural guidance and reference materials.
• Identify opportunities to improve document management processes and operational efficiency.
• Recommend enhancements to documentation standards, templates, and governance practices.
• Monitor trends, recurring questions, and audit findings to identify areas requiring additional documentation or clarification.
• Support strategic initiatives involving process redesign, system implementations, and workflow optimization.

Requirements:

• 2+ years of experience in technical writing, process documentation, healthcare operations, credentialing, provider enrollment, quality management, or a related field.
• Education: BA/BS or equivalent.
• Technical Skills: Technical and procedural writing, Microsoft Word, Excel, PowerPoint, and SharePoint, Process mapping and workflow documentation, Document version control and records management, Data analysis and reporting, Attention to detail and quality review.
• Ability to interpret and document complex business processes.
• Strong organizational and project coordination skills.
• Excellent written and verbal communication skills.
• Experience supporting provider enrollment, credentialing, Credentialing Verification Organization (CVO) activities, NC Medicaid, NCQA, CMS, or healthcare regulatory environments preferred.

Benefits:

• Comprehensive benefits and wellness packages.
• 401(k) plan with company match.
• Competitive pay and paid time off.
• Full-flex work week to own your priorities at work and at home.
• Award-winning culture of innovation and a military-friendly workplace.