Credentialing & Compliance Auditor: Quality & Audit Lead

Med-Metrix; Manila, Hinoba-an; On-site; PHP 420,000 - 660,000; Full time

Job summary

Med-Metrix in Manila is seeking a Credentialing & Compliance Auditor to ensure accuracy and regulatory adherence across credentialing and enrollment processes. You will audit work products, validate documentation, and support corrective actions to strengthen quality and audit readiness.

The role requires healthcare credentialing experience, policy interpretation skills, and strong attention to confidentiality.

Qualifications

• 2nd year undergraduate or bachelor’s degree required.
• 3+ years healthcare credentialing experience.
• Ability to interpret policies, procedures, and payer requirements.
• Proficiency in Microsoft Office Suite.
• Demonstrated discretion and confidentiality of sensitive information.
• Ability to apply audit methodology and communicate findings clearly.

Responsibilities

• Performs routine and targeted audits of credentialing and enrollment work products.
• Supports external audits by compiling documentation and responding to information requests.
• Validates documentation and data integrity; identifies compliance gaps and supports corrective actions.
• Audits delegated credentialing-related work products prior to submission.
• Compiles and reviews policies; ensures up-to-date copies on file.
• Tracks corrective actions from payers, verifies completion, and re-audits as needed.
• Maintains audit tools and produces periodic audit reports and trend summaries.
• Documents audit findings and communicates results to teams and leadership.
• Partners with credentialing staff to provide feedback.
• Protect PHI in accordance with HIPAA standards; adhere to information security policies.

Tools

Microsoft Office Suite

Job description

Med-Metrix in Manila is seeking a Credentialing & Compliance Auditor to ensure accuracy and regulatory adherence across credentialing and enrollment processes. You will audit work products, validate documentation, and support corrective actions to strengthen quality and audit readiness.

The role requires healthcare credentialing experience, policy interpretation skills, and strong attention to confidentiality.