Description Job Summary The Credentialing Auditor is responsible for auditing and overseeing credentialing processes both internally and for delegated entities. This role focuses on ensuring compliance with regulatory requirements while working collaboratively with internal departments and delegated entities. Functions & Job Responsibilities + Stay informed of changes to regulatory requirements related to credentialing and re-credentialing and communicate updates to internal teams and delegates. + Conduct pre-delegation credentialing audits to evaluate whether delegated entities are prepared to perform assigned activities. + Perform annual credentialing delegation audits to ensure vendors comply with agreements and continue to perform delegated activities according to requirements. + Conduct internal credentialing audits to ensure compliance with CMS requirements. + Develop, implement, and manage corrective action plans to address audit findings. + Monitor, analyze, and report data to appropriate stakeholders. + Provide leadership in communicating policies, procedures, and processes to ensure compliance and alignment with regulations. + Lead or participate in CMS mock audits and facilitate training sessions. + Oversee audit activities and report outcomes to leadership. + Collaborate on the development and execution of the audit program. + Maintain up-to-date knowledge of CMS regulations and requirements. + Partner with other departments to address issues, perform audits, and develop corrective actions. + Consult legal counsel when necessary to identify and resolve compliance or legal concerns. + Adhere to established policies, regulatory requirements, and professional standards. + Deliver professional service to both internal and external stakeholders. + Perform other duties as assigned. Requirements Qualifications Education & Experience: + Associate’s or Bachelor’s degree in healthcare or equivalent (preferred). + Valid driver’s license and reliable transportation required for onsite audit work. + One (1) to three (3) years of experience in credentialing or Medicare audit roles required. + A minimum of two (2) years of experience in credentialing and re-credentialing audit processes is necessary. + Advanced knowledge of Medicare Advantage CMS and California DMHC regulations. + In-depth understanding of HIPAA regulations. Skills: + Strong organizational, multitasking, and problem-solving abilities. + Ability to effectively interface with national and regional CMS offices. + Skilled in delivering presentations to both small and large groups. + Excellent verbal and written communication skills with the ability to maintain positive relationships with stakeholders. + Analytical and critical thinking skills to assess processes and drive results. + High degree of initiative, responsibility, and ability to maintain confidentiality. + Proficiency with advanced Microsoft Office applications and other relevant software tools. 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. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https://www.roberthalf.com/us/en/terms) .