Description The Credentialing Auditor is responsible for overseeing and auditing credentialing processes for both internal operations and delegated entities. This role supports the organization’s compliance with regulatory standards and fosters collaboration across departments and partners. Key Responsibilities: + Conduct pre-delegation credentialing audits to assess a delegate’s ability to perform assigned functions prior to formal delegation. + Perform annual credentialing audits of delegated entities to ensure continued compliance with contractual and regulatory requirements. + Audit internal credentialing processes to ensure compliance with CMS (Centers for Medicare & Medicaid Services) guidelines. + Develop, implement, and manage corrective action plans as needed. + Monitor, analyze, and report on credentialing data and audit outcomes. + Provide leadership in developing, communicating, and enforcing policies, procedures, and processes. + Participate in or lead CMS mock audits and provide training to relevant staff. + Lead audit activities and communicate findings and recommendations to leadership. + Contribute to the overall audit strategy and framework. + Maintain current knowledge of CMS regulations and credentialing standards. + Collaborate with other departments to address audit findings, issues, and compliance actions. + Consult with legal counsel when necessary to resolve compliance-related issues. + Perform duties in alignment with organizational policies, regulatory requirements, and professional standards. + Deliver professional service to both internal and external stakeholders. + Other duties as assigned. Additional Information: + This is a remote role; however, the candidate must be available to work during Pacific Time business hours. Requirements Education & Experience + Associate or Bachelor’s degree in healthcare or a related field preferred, or equivalent work experience. + Valid driver’s license, reliable transportation, and an acceptable driving record required for travel to onsite audits. + 1–3 years of experience in credentialing or Medicare audit functions. + At least 2 years of direct experience conducting credentialing and re-credentialing audits. + Strong understanding of Medicare Advantage (CMS) and California Department of Managed Health Care (DMHC) regulations. + In-depth knowledge of HIPAA privacy and security requirements. Skills + Excellent organizational skills, with the ability to manage multiple priorities and resolve problems effectively. + Experience working with regional and national CMS representatives. + Confident presenter, capable of delivering training to both small and large groups. + Strong written and verbal communication skills with the ability to build and maintain professional relationships with external partners. + Strong analytical and critical thinking abilities. + Ability to take initiative, work independently, maintain confidentiality, and demonstrate accountability. + Proficiency with Microsoft Office Suite and other standard business software. Physical & Work Environment Requirements + Capable of operating a computer, phone, and other standard office equipment; frequent use of keyboard and note-taking tools. + Ability to sit for extended periods and perform occasional physical tasks such as standing, bending, reaching, and lifting up to 15 lbs. + Must be able to clearly convey and receive information, including providing detailed instructions or feedback. + Work is performed in an office setting and/or remotely, with regular interaction with staff and external contacts. + May be required to work outside of standard business hours based on operational needs. (PST Hours) TalentMatch® ­Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles. Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more. Robert Half will consider for employment qualified applicants with arrest or conviction records in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information. © 2025 Robert Half. 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