Apply on Employer Site

Anders · 2 days ago

Payer Delegation and Compliance Specialist

St Louis, OK

Full-time

Hybrid

Mid, Senior Level

$68K/yr - $82K/yr

5+ years exp

Anders is one of the fastest-growing Credentialing Verification Organizations in the country, seeking a Payer Delegation and Compliance Specialist. This role is critical for ensuring compliance with NCQA regulatory standards and organizational policies, focusing on delegated credentialing, compliance monitoring, and enhancing client quality and operational efficiency.

Accounting

No H1B

Responsibilities

NCQA standards (understand and identify changes necessary to comply with NCQA standards)

CAQH Application retrieval and review

File Audit and Analysis for inappropriate documentation and updates to credentialing information

Conduct qualitative analysis of inappropriate documentation and updates

Payer Rosters must be completed in accordance with A5’s policy and procedures

Credentialing Information Integrity

Policy and procedure (writing and updating in accordance with payer and NCQA standards)

Trouble shoot and problem solve implementation challenges related to NCQA standards, policy, and procedures

Evolution of system controls requirements

Communicate regularly with the non-delegated provider enrollment and CVO teams

Support teamwork balancing by assisting in complex case management and troubleshooting

Collaborate cross-functionally with internal stakeholders such as compliance, provider relations, and operations

Maintain in-depth knowledge of evolving payer policies, credentialing regulations, and accreditation standards

Analyze data and produce reports on credentialing metrics and trends

Participate in continuous improvement initiatives and credentialing software optimization

Promote a collaborative, high-performance culture in a fully remote or hybrid team environment

Qualification

NCQA standardsCVO credentialing workflowsPayer delegation requirementsCredentialingEnrollment systemsExcelMicrosoft Office SuiteSelf-directedLeadership abilityProblem-solving skillsCommunication skillsAttention to detail

Required

Associate's degree required; Bachelor's degree in healthcare administration or a related field preferred

Minimum 5 years of experience in delegation and compliance, payer enrollment or healthcare credentialing, including experience with NCQA, URAC, and CMS standards

Proven leadership ability and experience mentoring or training junior staff

Advanced understanding of CVO credentialing workflows, payer delegation requirements, and NCQA regulatory compliance

High-level organizational and problem-solving skills with keen attention to detail

Excellent written and verbal communication; capable of handling sensitive issues with professionalism

Proficient in credentialing and enrollment systems, with strong Excel and Microsoft Office Suite skills

Self-directed, accountable, and capable of managing priorities in a fast-paced remote environment