Credentialing & Delegation Compliance Specialist

Ardent Health Services; Nashville (TN); Presencial; USD 75.000 - 95.000; Jornada completa

Descripción de la vacante

Ardent Health Services in Brentwood, TN seeks an experienced Credentialing Auditor to execute delegated credentialing operations, audits, and oversight reporting. You will prepare audit-ready documentation, build rosters, and monitor compliance with NCQA and payer standards across our network.

The ideal candidate has 4+ years in credentialing or managed care compliance, strong analytical skills, precise records, and the ability to collaborate with the Credentialing Manager and Credentials

Formación

• 4+ years of experience in credentialing, audit, or managed care compliance.
• Experience with credentialing file audit against defined standards.
• Strong analytical and reconciliation skills, particularly with roster and provider data.
• Precise documentation habits and comfort producing audit-ready evidence.

Responsabilidades

• Prepare files, documentation, and evidence for payer pre-delegation and annual audits.
• Collaborate with Manager of Credentialing to conduct internal file audits against NCQA and payer-specific delegation requirements; document findings and track remediation.
• Build, validate, and reconcile delegated rosters for audits prior to submission; investigate and resolve roster discrepancies.
• Compile quarterly and semi-annual oversight reports required under delegation agreements.
• Monitor ongoing compliance of credentialing operations against delegation standards and elevate gaps.
• Maintain delegation program documentation, polices, agreement records, and audit history.
• Support the Credentials Committee with reporting and materials as directed.
• Maintain historical knowledge of existing network delegation arrangements.

Conocimientos

Credentialing

Audit experience

Analytical skills

Documentation

Descripción del empleo

Ardent Health Services in Brentwood, TN seeks an experienced Credentialing Auditor to execute delegated credentialing operations, audits, and oversight reporting. You will prepare audit-ready documentation, build rosters, and monitor compliance with NCQA and payer standards across our network.

The ideal candidate has 4+ years in credentialing or managed care compliance, strong analytical skills, precise records, and the ability to collaborate with the Credentialing Manager and Credentials