Credentialing Lead – Delegated Payer Audits

Talkiatry; United States; Remote; USD 62,000 - 64,000; Full time

Job summary

An innovative mental health company is seeking a Credentialing Lead to enhance their delegated credentialing program. In this pivotal role, you will ensure compliance with accreditation standards and contractual obligations while supporting quarterly payor audits. Collaborating closely with various departments, you will maintain organized documentation and serve as a subject matter expert in credentialing. This is a unique opportunity to contribute to a fast-paced startup focused on improving mental health care, where your expertise will directly impact the quality of service provided. Join a diverse team dedicated to making a difference in the industry while enjoying a flexible work environment and excellent benefits.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401K with Match

Generous PTO

Paid Holidays

Paid Parental Leave

Flexible Work Location

Qualifications

• 3+ years of experience in healthcare credentialing required.
• Strong knowledge of NCQA standards and CMS requirements essential.

Responsibilities

• Support quarterly delegated payor audits and maintain documentation.
• Collaborate with cross-functional teams to validate credentialing materials.

Skills

Healthcare Credentialing

Delegated Credentialing

Payor Audit Preparation

NCQA Standards

Regulatory Requirements

SOP Development

Attention to Detail

Communication Skills

Cross-Functional Collaboration

Education

Bachelor's Degree

Tools

Medallion

Verifiable

Job description

Credentialing Lead – Delegated Payer Audits

This range is provided by Talkiatry. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$62,000.00/yr - $64,000.00/yr

We are seeking a Credentialing Lead – Delegated Payer Audits to strengthen our delegated credentialing program and ensure we remain in full compliance with accreditation standards and payor-specific contractual requirements. This role plays a key part in supporting quarterly payor audits, reinforcing quality across the credentialing lifecycle, and maintaining the documentation that demonstrates our adherence to delegation agreements — including internal policies, procedures, and credentialing file evidence.

You’ll work closely with the Credentialing Manager and collaborate cross-functionally with Compliance, ClinOps, Clinical Leadership, Payer Relations, and HR to prepare, track, and submit audit-ready materials. While this is not a people management role, it serves as a subject matter expert on delegated credentialing and provides backup QA support to the Credentialing Operations Lead when needed.

You will:

• Audit & Delegated Credentialing Program Support
• Assist with preparing for quarterly delegated payor audits by compiling required documentation, reviewing credentialing packets to submit, and helping ensure audit readiness
• Collaborate with cross-functional partners (e.g., Compliance, HR, ClinOps, Payer Relations, Clinical) to collect and validate credentialing materials as needed by payors
• Track and maintain organized documentation logs for audit submissions, committee approvals, and supporting materials
• Assist in submitting audit materials and updating rosters and other audit-related reporting
• Credentialing QA & File Review
• Conduct targeted quality reviews of completed credentialing files to verify alignment with delegated payor requirements and NCQA standards, particularly in preparation for audits
• Serve as a backup QA reviewer when the Credentialing Operations Lead is out of office or during periods of high volume
• Provide feedback to the Credentialing Manager on trends in QA issues and recommend process or training updates
• Policy, Documentation & Process Alignment
• Support development and refinement of internal credentialing SOPs and reference materials, ensuring alignment with delegated contract obligations and regulatory changes
• Help maintain documentation control and support tracking of changes to credentialing standards, forms, and workflows
• Participate in internal meetings to align with other Leads on quality and process expectations
• Other Responsibilities
• Join payor audit calls as needed, representing credentialing documentation efforts and assisting with follow-up tasks
• Contribute to department training materials and process improvement initiatives
• Provide back-up operational support as needed, including assisting with provider files or PSV workflows in high-volume periods

You have:

• 3+ years of experience in healthcare credentialing, with specific exposure to delegated credentialing and/or payor audit preparation
• Strong working knowledge of NCQA standards, CMS requirements, and delegated payor obligations
• Proven experience preparing for payor audits or maintaining documentation required under delegation agreements
• Ability to interpret and apply accreditation standards, regulatory requirements, and internal credentialing policies
• Skilled in creating and maintaining SOPs, policies, and audit documentation repositories
• Exceptional attention to detail and organizational skills, particularly in managing complex documentation workflows
• Polished verbal and written communication skills, with the professionalism and discretion required to represent the organization in payor audits and compliance discussions
• Comfortable working cross-functionally with compliance, clinical, and operational teams to gather and align documentation
• Experience with credentialing platforms (e.g., Medallion, Verifiable) preferred
• Bachelor’s degree preferred

Why Talkiatry:

• Top-notch team: we're a diverse, experienced group motivated to make a difference in mental health care
• Collaborative environment: be part of building something from the ground up at a fast-paced startup
• Flexible location: work where you want to, either remotely across the U.S. or from our HQ in NYC
• Excellent benefits: medical, dental, vision, effective day 1 of employment, 401K with match, generous PTO plus paid holidays, paid parental leave, and more!
• Grow your career with us: hone your skills and build new ones with our Learning team as Talkiatry expands
• It all comes back to care: we’re a mental health company, and we put our team’s well-being first

Talkiatry participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. only after a job offer is accepted and Form I-9 is completed. For more information on E-Verify, please visit the following: EVerify Participation & IER Right to Work.

At Talkiatry, we are an equal opportunity employer committed to a diverse, inclusive, and equitable workplace and candidate experience. We strive to create an environment where everyone has a sense of belonging and purpose, and where we learn from the unique experiences of those around us.

We encourage all qualified candidates to apply regardless of race, color, ancestry, religion, national origin, sexual orientation, age, citizenship, marital or family status, disability, gender, gender identity or expression, pregnancy or caregiver status, veteran status, or any other legally protected status.