What are the responsibilities and job description for the Delegation Operations Auditor, Senior position at Blue Shield Of California?
Job Description
Your Role
The Delegation Operations Auditor, Senior role is a critical role within Blue Shield of California's credentialing department. This role is responsible for assessing and ensuring the compliance of delegated entities with credentialing standards and regulatory requirements. Reporting to the Senior Manager of Delegation Operations, this role will conduct thorough audits and evaluations of the credentialing processes and data, ensuring that all providers within the delegated network meet established qualifications and standards. The Delegation Operations Auditor, Senior supports the improvement of credentialing practices and promotes high-quality care and patient safety within the network.
Responsibilities
Your Work
In this role, you will :
- Review and audit the credentialing processes of delegated providers to ensure compliance with internal policies, regulatory requirements, and industry standards
- Analyze credentialing documentation, including licenses, certifications, education, training, and professional experience, to verify the qualifications of healthcare providers
- Monitor adherence to precision and accuracy in the completion of credentialing applications and ongoing monitoring activities
- Collaborate with internal compliance and quality assurance teams to identify areas for improvement and ensure consistency in credentialing practices across delegated entities
- Develop and maintain audit checklists, protocols, and procedures to ensure effective oversight of credentialing practices
- Prepare detailed reports summarizing audit findings, compliance issues, and recommendations for corrective actions, and present these findings to management and relevant stakeholders
- Conduct educational sessions and provide support to delegated providers regarding credentialing requirements, best practices, and areas for improvement
- Participate in regular meetings with team members and stakeholders to discuss audit results, emerging issues, and solutions to enhance credentialing processes
- Assist in the development and implementation of policies and strategies to improve credentialing workflows and ensure timely credentialing of providers
- Stay current with state and federal regulations, industry guidelines, and best practices in healthcare credentialing to ensure compliance and enhance auditing practices
Qualifications
Your Knowledge and Experience
Pay Range :
The pay range for this role is : $80,300.00 to $120,450.00 for California.
Note :
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
About the Team
Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!
Our Values :
Our Workplace Model :
At Blue Shield of California, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.
Two Ways of Working :
Member-facing and approved out-of-state roles remain remote.
Physical Requirements :
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office / deskwork - Activity level : Sedentary, frequency most of work day.
Please click here for further physical requirement detail.
Equal Employment Opportunity :
External hires must pass a background check / drug screen. Qualified applicants with arrest records and / or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
Salary : $80,300 - $120,450
