Payer Delegation Compliance Specialist

Job Summary

A company is looking for a Payer Delegation and Compliance Specialist who is motivated to learn and collaborate while ensuring compliance with healthcare standards.

Key Responsibilities

• Ensure compliance with NCQA standards through delegated credentialing and performance assessments
• Collaborate with internal teams to support complex case management and maintain quality control
• Analyze credentialing data and participate in continuous improvement initiatives

Required Qualifications

• Associate's degree required; Bachelor's degree in healthcare administration or related field preferred
• Minimum 5 years of experience in delegation and compliance, payer enrollment, or healthcare credentialing
• Advanced understanding of CVO credentialing workflows and NCQA regulatory compliance
• Certification as a NAMSS Certified Provider Enrollment Specialist (CPES) is strongly preferred
• Proficient in credentialing and enrollment systems, with strong Excel and Microsoft Office skills