Delegation Oversight & Compliance Specialist

Ardent Health Services; Nashville (TN); On-site; USD 75,000 - 95,000; Full time

Job summary

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

Qualifications

• 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.

Responsibilities

• 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.

Skills

Credentialing

Audit experience

Analytical skills

Documentation

Job description

Overview

Ardent Health is a leading provider of healthcare in communities across the country. With a focus on consumer-friendly processes and investments in innovative services and technologies, Ardent is passionate about making healthcare better and easier to access. We are driven by our purpose of caring for people: our patients, our communities and one another.

Located in Brentwood, Tennessee, Ardent has earned a reputation as one of the industry’s strongest and most innovative healthcare systems. Our facilities and clinics are consistently recognized among healthcare’s best employers. We recognize each hospital and clinic is as unique as the community it serves. We strive to maintain strong community ties through advisory boards, contributions, charitable care, education and outreach.

• 30 hospitals


• 280 sites of care


• 4,281 beds


• 24,000+ team members


• 8,200+ nurses


• 1,800+ aligned providers


• 5.8M annual provider encounters


• 421 medical residents

Ardent makes considerable investments in people, technology, facilities, and communities, producing high quality care and extraordinary results. From newly constructed facilities and expanded services, to lifesaving technology and outstanding opportunities for employees, Ardent is committed to providing its hospitals and clinics the tools needed to succeed.

We believe it is this mix of corporate support and local autonomy that equips our teams for success.

Job Overview

Executes the operational work of delegation oversight - audit preparation and response, roster accuracy, oversight reporting, and monitoring compliance of credentialing operations against delegation requirements.

Responsibilities

• 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.

Qualifications

Job Requirements:

• 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.

Preferred Job Requirements

• CPCS certification, or eligibility with intent to certify.


• Direct experience supporting payer delegation audits.


• Roster build and submission experience.


• Knowledge of NCQA delegation standards.