Credentialing Auditor

Job Summary

A company is looking for an Auditor, Delegate Credentialing.

Key Responsibilities

• Conduct credentialing audits to ensure compliance with regulatory and contractual standards
• Engage with delegated provider organizations to correct deficiencies and enhance performance
• Validate corrective actions for credentialing compliance and report audit findings

Required Qualifications

• 3-5 years of credentialing experience in an HMO, Medicare Advantage, and/or IPA setting
• Prior experience in conducting oversight audits of delegated entities and/or ancillary providers
• Demonstrable knowledge of NCQA, HICE, or related credentialing requirements
• High school diploma required; Bachelor's degree in a related subject preferred
• Strong knowledge of Medicare audit processes and applicable state and federal regulatory requirements