Credentialing Audit Specialist

• Employment Type: Full-Time

One of our clients is hiring a Credentialing Audit Specialist responsible for auditing completed credentialing applications and developing efficient, compliant audit processes. This role ensures provider files meet regulatory and accreditation standards while supporting continuous quality improvement initiatives.

The Credentialing Audit Specialist coordinates and conducts detailed audits of provider credentialing and re-credentialing files. This position analyzes documentation for completeness, accuracy, and compliance gaps, while preparing reports to track findings and enhance policies, procedures, and staff training materials.

• Conduct audits of credentialing and re-credentialing applications
• Analyze provider files for completeness, accuracy, work history gaps, and reference verification
• Manage multiple concurrent audits and related projects
• Ensure audit tools comply with National Committee for Quality Assurance (NCQA), The Joint Commission (TJC), and Centers for Medicare & Medicaid Services (CMS) standards

• Prepare audit reports tracking and trending findings
• Assist in developing staff training guides, policies, and procedures
• Support continuous improvement of credentialing workflows
• Coordinate credentialing processes for assigned providers

• Prioritize and manage multiple deadlines effectively
• Maintain high standards of documentation accuracy
• Support organizational competency and compliance expectations

• High School Diploma or equivalent required
• Bachelor’s Degree preferred
• Minimum 3 years of medical staff and/or managed care credentialing experience preferred
• Certified Provider Credentialing Specialist (CPCS) preferred
• Strong analytical, reporting, and organizational skills
• Knowledge of accreditation and regulatory credentialing standards

• Schedule:
  
  Monday–Friday, 8:00 AM – 5:00 PM
• Full-time role in healthcare credentialing and compliance
• High-impact position ensuring regulatory adherence and audit integrity
• Collaborative environment supporting medical staff operations