Delegation Operations Auditor, Senior

Blue Shield of California•Long Beach, CA

2d•$81,950 - $138,508•Hybrid

About The Position

The Healthcare Quality Delegation Oversight team conducts routine and moderately complex audits of delegated entities to ensure delegate performance and compliance meets standards and focuses on quality and affordability of member care. 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.

Requirements

Experience in auditing delegated entities.
Knowledge of credentialing standards and regulatory requirements.
Ability to conduct thorough audits and evaluations of credentialing processes and data.
Understanding of provider qualifications and standards.
Skills in improving credentialing practices.
Focus on high-quality care and patient safety.

Responsibilities

Conduct routine and moderately complex audits of delegated entities.
Ensure delegate performance and compliance meets standards.
Focus on quality and affordability of member care.
Assess and ensure the compliance of delegated entities with credentialing standards and regulatory requirements.
Conduct thorough audits and evaluations of credentialing processes and data.
Ensure all providers within the delegated network meet established qualifications and standards.
Support the improvement of credentialing practices.
Promote high-quality care and patient safety within the network.