What are the responsibilities and job description for the Delegation Oversight & Compliance Specialist position at Ardent Health?
Overview
Responsibilities
Qualifications
Ardent Health is a leading provider of healthcare in communities across the country. With a focus on consumer-friendly processes and investments in innovative services and technologies, Ardent is passionate about making healthcare better and easier to access. We are driven by our purpose of caring for people: our patients, our communities and one another.
Located in Brentwood, Tennessee, Ardent has earned a reputation as one of the industry’s strongest and most innovative healthcare systems. Our facilities and clinics are consistently recognized among healthcare’s best employers. We recognize each hospital and clinic is as unique as the community it serves. We strive to maintain strong community ties through advisory boards, contributions, charitable care, education and outreach.
Ardent includes:
- 30 hospitals
- 280 sites of care
- 4,281 beds
- 24,000 team members
- 8,200 nurses
- 1,800 aligned providers
- 5.8M annual provider encounters
- 421 medical residents
Ardent makes considerable investments in people, technology, facilities, and communities, producing high quality care and extraordinary results. From newly constructed facilities and expanded services, to lifesaving technology and outstanding opportunities for employees, Ardent is committed to providing its hospitals and clinics the tools needed to succeed.
We believe it is this mix of corporate support and local autonomy that equips our teams for success.
Job Overview:
Executes the operational work of delegation oversight – audit preparation and response, roster accuracy, oversight reporting, and monitoring compliance of credentialing operations against delegation requirements.
Responsibilities
- Prepares files, documentation, and evidence for payer pre-delegation and annual audits.
- Collaborates with Manager of Credentialing to conduct internal file audits against NCQA and payer-specific delegation requirements; document findings and track remediation.
- Builds, validates, and reconciles delegated rosters for audits prior to submission; investigate and resolve roster discrepancies.
- Compiles quarterly and semi-annual oversight reports required under delegation agreements.
- Monitors ongoing compliance of credentialing operations against delegation standards and escalates gaps.
- Maintains delegation program documentation, polices, agreement records, and audit history.
- Supports the Credentials Committee with reporting and materials as directed.
- Maintains historical knowledge of existing network delegation arrangements.
Qualifications
Job Requirements:
- 4 years of experience in credentialing, audit, or managed care compliance
- Experience with credentialing file audit against defined standards
- Strong analytical and reconciliation skills, particularly with roster and provider data
- Precise documentation habits and comfort producing audit-ready evidence
Preferred Job Requirements:
- CPCS certification, or eligibility with intent to certify
- Direct experience supporting payer delegation audits
- Roster build and submission experience
- Knowledge of NCQA delegation standards