Delegation Operations Auditor, Senior

Your Role

The Delegation Operations Auditor, Senior role is a critical role within Blue Shield of California's credentialing department. This role is responsible for assessing and ensuring the compliance of delegated entities with credentialing standards and regulatory requirements. Reporting to the Senior Manager of Delegation Operations, this role will conduct thorough audits and evaluations of the credentialing processes and data, ensuring that all providers within the delegated network meet established qualifications and standards. The Delegation Operations Auditor, Senior supports the improvement of credentialing practices and promotes high-quality care and patient safety within the network.

Your Knowledge and Experience

• Requires a Bachelor's degree or equivalent years of experience
• Requires equivalent experience and 5 years of prior relevant experience in auditing of claims, credentialing and / or re-credentialing
• Experience working in a health plan, hospital, or healthcare organization is preferred
• Proficiency in credentialing and primary source verification software is preferred
• Experience with accreditation processes and quality improvement initiatives related to credentialing is preferred
• Familiarity with healthcare regulations and compliance requirements is preferred
• Certification in healthcare credentialing (e.g., CPCS, CPMSM) is preferred
• Strong understanding of credentialing standards, including those set by the National Committee for Quality Assurance (NCQA) and The Joint Commission
• Excellent analytical skills with a keen attention to detail and the ability to identify discrepancies and compliance issues
• Strong interpersonal and communication skills, with the ability to work effectively with diverse teams and stakeholders
• Ability to manage multiple priorities and deadlines in a dynamic environment, demonstrating strong organizational skills