Delegated Credentialing QA Coordinator

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.