Credentialing Lead - New York

A company is looking for a Credentialing Lead - Delegated Payor Audits. Key Responsibilities Assist in preparing for quarterly delegated payor audits by compiling required documentation and ensuring audit readiness Conduct quality reviews of credentialing files to verify compliance with delegated payor requirements and NCQA standards Support the development of internal credentialing SOPs and maintain documentation control for credentialing standards Required Qualifications 3+ years of experience in healthcare credentialing, specifically with delegated credentialing and payor audits Strong knowledge of NCQA standards, CMS requirements, and delegated payor obligations Experience in preparing for payor audits and maintaining necessary documentation Ability to interpret accreditation standards and internal credentialing policies Bachelor's degree preferred

Apr 17, 2025 - 18:29

A company is looking for a Credentialing Lead - Delegated Payor Audits. Key Responsibilities Assist in preparing for quarterly delegated payor audits by compiling required documentation and ensuring audit readiness Conduct quality reviews of credentialing files to verify compliance with delegated payor requirements and NCQA standards Support the development of internal credentialing SOPs and maintain documentation control for credentialing standards Required Qualifications 3+ years of experience in healthcare credentialing, specifically with delegated credentialing and payor audits Strong knowledge of NCQA standards, CMS requirements, and delegated payor obligations Experience in preparing for payor audits and maintaining necessary documentation Ability to interpret accreditation standards and internal credentialing policies Bachelor's degree preferred