Accountabilities:
The Delegated Credentialing QA Coordinator will support credentialing quality management by ensuring provider documentation, audits, and compliance processes meet required standards. Key responsibilities include:
Review BCBA and behavioral health provider credentialing packets for completeness, accuracy, and proper primary source verification.
Conduct routine and ad hoc audits of delegated credentialing files to ensure compliance with organizational, payer, accreditation, and regulatory requirements.
Monitor delegated entities for adherence to contractual requirements, including turnaround times, documentation standards, and verification processes.
Maintain audit tools, tracking systems, checklists, and reporting dashboards to monitor compliance performance and identify improvement opportunities.
Support pre-delegation and annual delegation audits by preparing documentation and ensuring audit readiness.
Collaborate with credentialing teams to align processes, policies, and quality standards.
Review and update credentialing policies to reflect current regulatory, accreditation, and payer expectations.
Partner with enrollment teams to support Medicaid, MCO, and commercial payer applications while improving submission accuracy and efficiency.
Assist with the development and delivery of training materials for internal teams and delegated entities.
Contribute to quality improvement initiatives, process optimization efforts, and expansion into new states and payer networks.
Requirements:
The successful candidate will bring experience in healthcare credentialing, quality assurance, compliance, and process management, with strong attention to detail and organizational skills. Required qualifications include:
Experience with healthcare credentialing, delegated credentialing, provider enrollment, quality assurance, or related healthcare operations functions.
Knowledge of credentialing requirements, primary source verification, payer standards, and healthcare compliance practices.
Familiarity with BCBA, behavioral health, or provider network credentialing processes preferred.
Experience conducting audits, maintaining compliance documentation, and identifying process improvement opportunities.
Ability to review complex documentation with accuracy and consistency.
Strong organizational skills with the ability to manage multiple priorities and meet deadlines in a remote environment.
Experience creating and maintaining audit tools, dashboards, reports, or tracking systems.
Strong written and verbal communication skills with the ability to collaborate across teams.
Ability to develop training materials and support internal education initiatives.
Detail-oriented mindset with a commitment to accuracy, compliance, and continuous improvement.
Comfortable working independently within a fully remote, asynchronous team environment.
Benefits:
The role offers a flexible remote work environment and a competitive compensation package, including:
Annual salary range of $72,000 – $84,000 .
Fully remote position with the ability to work from anywhere in the United States.
Flexible working hours and an asynchronous team culture.
Opportunity to contribute to the expansion of accessible behavioral healthcare services.
Collaborative environment focused on innovation, quality, and operational excellence.
Inclusive workplace culture committed to supporting employees from diverse backgrounds and experiences.
How Jobgether works:
We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
We appreciate your interest and wish you the best!
Why Apply Through Jobgether?
Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.
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