Credentialing & Compliance Auditor — Quality & Audit Lead

Med-Metrix; Pasig; On-site; PHP 400,000 - 680,000; Full time

Job summary

Med-Metrix in Pasig, Philippines, seeks a Credentialing & Compliance Auditor to ensure accuracy, completeness, and regulatory alignment of credentialing and enrollment processes. You will audit, validate documents, identify compliance gaps, and support corrective actions to strengthen quality and audit readiness.

You will collaborate with operational teams, delegated partners, and external stakeholders to uphold policy adherence and HIPAA-related standards.

Qualifications

• 2nd year undergraduate or bachelor's degree required.
• 3+ years healthcare credentialing experience.
• Ability to interpret policies, procedures, and payer/agency requirements.
• Ability to learn credentialing/enrollment systems.
• Demonstrated discretion and ability to maintain confidentiality of sensitive information.
• Ability to apply audit methodology, document findings clearly, and communicate issues with diplomacy and precision.
• Proficiency in Microsoft Office Suite.
• Strong interpersonal skills and ability to communicate across all levels.

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 for accuracy and completeness.
• Compiles and reviews policies and procedures to ensure an up-to-date copy is on file.
• Tracks corrective actions from payers, verifies completion, and performs 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 and enrollment staff to provide feedback.
• Complies with HIPAA policies and limits PHI viewing to the minimum necessary.

Skills

Interpersonal skills

Communication at all levels

Problem solving

Discretion & confidentiality

Policy interpretation

Audit methodology

Attention to detail

Education

Undergraduate or Bachelor's degree

Tools

Microsoft Office Suite

Job description

Med-Metrix in Pasig, Philippines, seeks a Credentialing & Compliance Auditor to ensure accuracy, completeness, and regulatory alignment of credentialing and enrollment processes. You will audit, validate documents, identify compliance gaps, and support corrective actions to strengthen quality and audit readiness.

You will collaborate with operational teams, delegated partners, and external stakeholders to uphold policy adherence and HIPAA-related standards.