Delegation Operations Auditor, Senior

Your Role

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.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

• Requires a Bachelor's degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree
• Requires 5 years of prior relevant experience in auditing of claims, credentialing and/or re-credentialing
• Strong critical thinking, analytical, and problem-solving skills
• Strong attention to detail skills and the ability to identify discrepancies and compliance issues
• Strong understanding of credentialing standards, including those set by the National Committee for Quality Assurance (NCQA) and The Joint Commission
• 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
• Proficiency in credentialing and primary source verification software is preferred
• Experience working in a health plan, hospital, or healthcare organization 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

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.