Specialist I, Audit and Accreditation

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Summary of Position

This position is responsible for coordinating the processes and systems used to support corporate and delegated credentialing audits. The position responds to, conducts, and documents corporate audit and delegation activities to comply with client contractual requirements, NCQA credentialing standards and guidelines, federal, state, and other government regulatory requirements.

This position reports to the Director of Delegation and Accreditation and interacts with internal and external customers to promote collegial client relationships and respond to client executive regarding client specific concerns. Additionally, this position collaborates with the network credentialing reporting team to ensure the thoroughness and accuracy of all client deliverables including corrective action plans. This position also supports the corporate-wide audit deliverables.

Essential Duties and Responsibilities

• Works with team members to ensure annual audits, pre-assessments, provider rosters, file reviews, corrective actions, and reports are accurate, complete, and meet corporate and client deliverable deadlines as directed. Updates and maintains delegated credentialing tracker tool to track internal performance.
• Provides compliance oversight for client reporting requirements and as needed for client corrective action plans. Reviews new client delegation credentialing agreements and current client delegation amendments to ensure compliance with NCQA standards. Recommends changes to credentialing agreements as needed and collaborates with Contracts staff on all agreements
• Monitors and tracks health plan client data and reporting requests. Collaborates with credentialing team to review the accuracy and completeness of provider rosters/provider files and delivers to health plan clients. Works to ensure client satisfaction with all deliverables.
• Works with team members to respond to, document, investigate, and work to resolve the issues identified in client corrective action plans. Monitors progress toward successfully achieving the requirements of the client specific corrective action plans and closing the corrective action plan.
• Liaison to client executives and health plan clients to support delegated credentialing activities and responds to health plan client requests in a timely fashion.
• Is responsible for creating and updating delegated credentialing policies and procedures as needed to ensure NCQA compliance and other federal/state regulatory requirements including Delegated Credentialing FAQ, Data Request form, and Client Audit Tracker
• Summarizes and analyzes department key performance indicators and prepares monthly status report and reviews with team members.
• Develops and maintains accessible (Sharepoint) database of delegation agreements, working with sales, client executives, credentialing, compliance, and legal teams as needed.
• Identifies opportunities for process improvement and makes recommendations based upon client feedback.
• Performs reviews and quality controls of NCQA credentialing accreditation documentation including staging of documents, uploads to IRT, pre-site visit activities, file exchanges, credential file preparation, etc.
• Assesses NCQA documentation for completeness. Works with business owner and subject matter experts to update documentation as needed for the triennial accreditation site visit.
• Performs other duties as assigned.

The time spent on each responsibility reflects an estimate and is subject to change dependent on business needs.

Supervisory Responsibilities

No.

Required Qualifications

• 3+ years of managed care experience
• Strong written and verbal communications skills, including the ability to prepare written reports and present findings to management
• Knowledge of Medicare and Medicaid health care programs and understanding of government programs and provider enrollment and credentialing regulations and requirements preferred
• Demonstrated knowledge of regulatory/accreditation requirements and standards (NCQA, AACME)
• Bachelor's Degree or equivalent combination of education and experience.

Preferred Qualifications

• Ability to establish and maintain positive internal and external client relationships, building trust and respect by consistently meeting and exceeding expectations
• Data analysis experience and experience developing and analyzing reports
• PC proficiency, proficiency in Microsoft Office applications and ability to effectively utilize other software and systems as needed
• Impeccable attention to detail

The base salary range for this position is$60,000 - $70,000.In addition to a base salary, this position is eligible for a performance bonus and benefits (subject to eligibility requirements) listed here:Teladoc Health Benefits 2025.Total compensation is based on several factors including, but not limited to, type of position, location, education level, work experience, and certifications.This information is applicable for all full-time positions.

Teladoc Health will not sponsor or transfer employment work visas for this position. Applicants must be currently authorized to work in the United States without the need for visa sponsorship now or in the future.