Healthcare Credentialing & Compliance Auditor

Med-Metrix; Pasig; On-site; PHP 420,000 - 580,000; Full time

Job summary

Med-Metrix is seeking a Credentialing & Compliance Auditor to ensure the accuracy, completeness, and regulatory adherence of credentialing and enrollment processes across the organization.

You will perform audits, validate documents, identify compliance gaps, and support corrective actions while collaborating with teams, payers, and external partners to maintain audit readiness and data integrity.

Qualifications

• 3+ years healthcare credentialing experience
• Ability to interpret policies, procedures, and payer/agency requirements and apply them consistently
• Ability to learn credentialing/enrollment systems
• Demonstrated discretion and ability to maintain confidentiality of sensitive information
• Proficiency in Microsoft Office Suite
• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
• Excellent written and verbal communication skills required

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 to strengthen quality, standardization, and audit readiness
• Audits delegated credentialing-related work products (e.g., roster files and supporting documentation) to ensure accuracy and completeness prior to submission
• Tracks corrective actions from payers, verifies completion, and performs re-audits as needed to confirm sustained compliance
• Maintains audit tools (checklists, sampling logs, scorecards) and produces periodic audit reports and trend summaries
• Documents audit findings, assigns issue categories, and communicates results to operational teams and leadership
• Partners with credentialing and enrollment staff to provide feedback.
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with HIPAA standards
• Always Understand and comply with Information Security and HIPAA policies and procedures
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties.

Skills

Interpersonal skills

Communication (written & verbal)

Microsoft Office Suite

Education

Bachelor's degree or 2nd year undergrad

Tools

Microsoft Office Suite

Job description

Med-Metrix is seeking a Credentialing & Compliance Auditor to ensure the accuracy, completeness, and regulatory adherence of credentialing and enrollment processes across the organization.

You will perform audits, validate documents, identify compliance gaps, and support corrective actions while collaborating with teams, payers, and external partners to maintain audit readiness and data integrity.