Specialist III, Enrollment Operations

Manage delegated credentialing operations and ensure NCQA-compliant audits and payor relationships.

• •The Delegated Credentialing Specialist manages end-to-end delegated credentialing agreements with health insurance payors, ensuring compliance with NCQA and payor standards and maintaining audit-ready credentialing files.
• •Key Responsibilities Manage delegated credentialing operations including pre-delegation and annual audits Serve as primary payor contact and handle communications and data requests Prepare and execute audits, resolve corrective action plans Maintain audit-ready files and perform roster reconciliations Build reporting packages and track regulatory/accreditation changes Requirements 2-5 years enrollment or credentialing experience with delegated credentialing Working knowledge of NCQA credentialing standards Experience with delegated credentialing audits and compliance Strong documentation, attention to detail, and cross-functional communication