Delegated Credentialing Specialist — Payer Compliance

Tava Health; Georgia; On-site; USD 65,000 - 95,000; Full time

Job summary

Tava Health is seeking a Delegated Credentialing Specialist to own the day-to-day delegation program across assigned payer relationships. You will manage audits, compliance reporting, and credentialing file accuracy while collaborating with internal teams and delegated entities.

You’ll support credentialing for Nurse Practitioners and group practices, maintain audit-ready records, and drive timely credentialing actions.

Qualifications

• 2–5 years of credentialing and enrollment experience, including at least 2 years specifically focused on delegated credentialing.
• Certified Provider Credentialing Specialist (CPCS) certification.
• Ability to manage multiple payer relationships and responsibilities with minimal oversight.
• Self-motivated team player who thrives in a multi-tasking environment and can adjust priorities.
• High attention to detail, strong organization, and excellent documentation skills.
• Outstanding written and verbal communication.
• High-growth/tech-enabled healthcare background preferred; behavioral health experience is a plus.
• Familiarity with CAQH, NPDB, PECOS, state licensing resources, credentialing software, and payer rostering tools.

Responsibilities

• Oversee delegated credentialing activities for an assigned payer portfolio, including readiness reviews, ongoing compliance monitoring, recurring reporting, and annual audits.
• Monitor NCQA guidance, state regulations, and other accreditation updates; assess operational impact and implement necessary compliance changes.
• Prepare for and facilitate pre-delegation and annual credentialing audits in accordance with NCQA and payer-specific requirements; develop and track corrective action plans through resolution.
• Maintain complete, audit-ready credentialing records, including primary source verification, Credentialing Committee documentation, and adverse action logs.
• Prepare recurring deliverables for delegated partners and payers, such as provider rosters, audit materials, and credentialing activity reports.
• Monitor average time to credential and support targets by identifying delays, managing follow-up, and escalating issues as needed.
• Partner with Enrollment, Partnerships, Revenue Cycle, Legal/Compliance, and other teams to maintain accurate provider data and routinely reconcile internal records against delegated payer rosters.
• Serve as a reliable point of contact for payer communications related to delegated credentialing activities, audits, provider records, and follow-up items.
• Support the implementation of new delegated credentialing agreements, including the processes and controls needed to fulfill contractual requirements.

Skills

Credentialing experience

Multi-tasking

Attention to detail

Communication

Self-motivated

Education

CPCS certification

Tools

CAQH

NPDB

PECOS

Credentialing software

Payer rostering tools

Job description

Tava Health is seeking a Delegated Credentialing Specialist to own the day-to-day delegation program across assigned payer relationships. You will manage audits, compliance reporting, and credentialing file accuracy while collaborating with internal teams and delegated entities.

You’ll support credentialing for Nurse Practitioners and group practices, maintain audit-ready records, and drive timely credentialing actions.