Delegation Oversight & Compliance Specialist

Ardent Health • Nashville, TN

3d

About The Position

Executes operational work for delegation oversight, including audit preparation and response, roster accuracy, oversight reporting, and monitoring credentialing operations for compliance with delegation requirements. The role prepares documentation and evidence for payer audits, conducts internal file audits with the Manager of Credentialing, tracks remediation, reconciles delegated rosters, compiles required oversight reports, maintains program records, and supports the Credentials Committee.

Requirements

• At least 4 years of experience in credentialing, audit, or managed care compliance.
• Experience auditing credentialing files against defined standards.
• Strong analytical and reconciliation skills, particularly with roster and provider data.
• Precise documentation habits and comfort producing audit-ready evidence.

Nice To Haves

• CPCS certification, or eligibility with intent to certify.
• Direct experience supporting payer delegation audits.
• Roster build and submission experience.
• Knowledge of NCQA delegation standards.

Responsibilities

• Prepare files, documentation, and evidence for payer pre-delegation and annual audits.
• Collaborate with the 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 before 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 escalate gaps.
• Maintain delegation program documentation, policies, agreement records, and audit history.
• Support the Credentials Committee with reporting and materials as directed.
• Maintain historical knowledge of existing network delegation arrangements.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed