Tenet Healthcare
Delegation Oversight Auditor/Coordinator - Hybrid in Dallas, TX
Tenet Healthcare, Dallas, Texas, United States, 75215
Overview
Delegation Oversight Auditor/Coordinator - Hybrid in Dallas, TX is a senior-level role focused on auditing, contract compliance, and data integrity to support delegated relationships with health plans across multiple states. The position requires deep knowledge of Payor Credentialing regulatory requirements, including NCQA, URAC, CMS, and state-specific standards, and plays a critical part in supporting the organization\'s physician manpower and managed care strategy. Responsibilities
Lead and participate in delegation oversight audits conducted by health plans and NCQA accreditation audits. Ensure credentialing and recredentialing practices meet regulatory and contractual requirements (NCQA/URAC/CMS/State). Prepare and maintain documentation required for delegation readiness and ongoing compliance. Review, redline, and negotiate delegation agreements and contracts with health plans to align with internal strategy and regulatory obligations. Define roles, responsibilities, reporting metrics, and performance expectations across internal teams to ensure adherence. Monitor and maintain provider data integrity to align with contractual requirements, timely participation dates, and claims payments. Oversee timely and accurate reporting to payors, including rosters, performance metrics, and audit responses. Resolve data discrepancies and claim loading issues in partnership with internal teams and health plan contacts. Support onboarding and maintenance of provider portfolios to ensure adherence to credentialing and contracting standards. Track and resolve delayed claims and credentialing issues due to data delays or authorization gaps to mitigate impact on patient care and revenue. Collaborate with internal credentialing, contracting, and operations teams to align with health plan expectations. Identify issues or risks to compliance and escalate to the Director when required. Maintain detailed documentation to support audits, internal reviews, and health plan submissions. Ensure accurate and timely loading of provider data to avoid claims delays or denials. Act as a liaison between internal departments and external health plan partners; build and maintain positive relationships with stakeholders at all levels, including executive leadership. Investigate root causes of compliance or operational issues and drive corrective action; support efforts to improve delegation performance and provider onboarding workflows. Qualifications
Education
Bachelor’s Degree in Healthcare Administration, Business, or related field preferred. Equivalent experience may be considered. Experience
Minimum 3–5 years of experience in Delegation Oversight, Credentialing, Managed Care, or Health Plan auditing. Strong understanding of credentialing standards from NCQA, URAC, CMS, and State regulations. Experience working with national and regional payors and understanding of managed care contracting structures. Skills & Competencies
Excellent verbal and written communication skills. High attention to detail and organizational skills. Ability to manage multiple priorities in a fast-paced environment. Strong analytical and problem-solving skills, including root cause analysis. Proficiency in identifying and resolving claim and data load issues. Adept at obtaining and verifying authorizations and referrals when necessary. Experience in contract review and negotiation within delegated credentialing frameworks. Vaccination policy: Tenet Healthcare/USPI complies with applicable federal, state, and local laws regarding mandatory vaccination. If offered and required, proof of full vaccination or an approved religious/medical exemption will be requested prior to start, with regular testing if exempted. Employment Details
Employment type: Full-time Seniority level: Associate Job function: Accounting/Auditing and Finance Industries: Hospitals and Health Care and Medical Practices
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Delegation Oversight Auditor/Coordinator - Hybrid in Dallas, TX is a senior-level role focused on auditing, contract compliance, and data integrity to support delegated relationships with health plans across multiple states. The position requires deep knowledge of Payor Credentialing regulatory requirements, including NCQA, URAC, CMS, and state-specific standards, and plays a critical part in supporting the organization\'s physician manpower and managed care strategy. Responsibilities
Lead and participate in delegation oversight audits conducted by health plans and NCQA accreditation audits. Ensure credentialing and recredentialing practices meet regulatory and contractual requirements (NCQA/URAC/CMS/State). Prepare and maintain documentation required for delegation readiness and ongoing compliance. Review, redline, and negotiate delegation agreements and contracts with health plans to align with internal strategy and regulatory obligations. Define roles, responsibilities, reporting metrics, and performance expectations across internal teams to ensure adherence. Monitor and maintain provider data integrity to align with contractual requirements, timely participation dates, and claims payments. Oversee timely and accurate reporting to payors, including rosters, performance metrics, and audit responses. Resolve data discrepancies and claim loading issues in partnership with internal teams and health plan contacts. Support onboarding and maintenance of provider portfolios to ensure adherence to credentialing and contracting standards. Track and resolve delayed claims and credentialing issues due to data delays or authorization gaps to mitigate impact on patient care and revenue. Collaborate with internal credentialing, contracting, and operations teams to align with health plan expectations. Identify issues or risks to compliance and escalate to the Director when required. Maintain detailed documentation to support audits, internal reviews, and health plan submissions. Ensure accurate and timely loading of provider data to avoid claims delays or denials. Act as a liaison between internal departments and external health plan partners; build and maintain positive relationships with stakeholders at all levels, including executive leadership. Investigate root causes of compliance or operational issues and drive corrective action; support efforts to improve delegation performance and provider onboarding workflows. Qualifications
Education
Bachelor’s Degree in Healthcare Administration, Business, or related field preferred. Equivalent experience may be considered. Experience
Minimum 3–5 years of experience in Delegation Oversight, Credentialing, Managed Care, or Health Plan auditing. Strong understanding of credentialing standards from NCQA, URAC, CMS, and State regulations. Experience working with national and regional payors and understanding of managed care contracting structures. Skills & Competencies
Excellent verbal and written communication skills. High attention to detail and organizational skills. Ability to manage multiple priorities in a fast-paced environment. Strong analytical and problem-solving skills, including root cause analysis. Proficiency in identifying and resolving claim and data load issues. Adept at obtaining and verifying authorizations and referrals when necessary. Experience in contract review and negotiation within delegated credentialing frameworks. Vaccination policy: Tenet Healthcare/USPI complies with applicable federal, state, and local laws regarding mandatory vaccination. If offered and required, proof of full vaccination or an approved religious/medical exemption will be requested prior to start, with regular testing if exempted. Employment Details
Employment type: Full-time Seniority level: Associate Job function: Accounting/Auditing and Finance Industries: Hospitals and Health Care and Medical Practices
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