Senior Audit Analyst, Provider Onboarding

JOB DESCRIPTION

This position is responsible for the overall success of each audit or exam assigned. This includes analyzing and reviewing requested information, advising the business and / or forming responses, proposing different options for resolving issues, interpreting and documenting requirements, conducting meetings as needed (externally and internally), and alerting management of potential issues. Other responsibilities include collaborating with internal customers to ensure the audit / exam responses are accurate, timelines are met, and their internal activities are compliant. This position also acts as a trainer and mentor to other team members, provides strong industry knowledge and understanding of the enterprise's structure, and is a trusted SME for all audit / exam activities.

RESPONSIBILITIES

• Manages all audits / exams as projects, focusing on audits and exams with added complexity. Establishes tasks, timelines, and deliverables to meet deadlines with dependencies on other departments. Identifies, engages, and collaborates with respective stakeholders throughout each project.
• Creates and / or provides guidance in the drafting of audit / exam responses that align with current process and materials and may be referenced in the audit / exam, ensuring accurate, defendable, clear, and concise responses. Reviews lower-level team members' responses prior to submission.
• Analyzes unexpected findings or trends and shares analysis, potential risks, and recommendations with stakeholders to support adherence to compliance standards.
• Completes Root Cause Analysis for each issue or Corrective Action Plan (CAP). Manages and tracks issue to completion to prevent repeat findings.
• Provides monthly assessment on adherence to compliance standards, open corrective action plans, and / or performance guarantees.
• Researches and resolves issues related to outdated information or unclear processes; Proactively creates and / or enhances audit tools to mitigate potential future issues and provides feedback or recommendations to management.
• Leads cross-functional meetings to update stakeholders on pertinent issue resolutions, process changes and improvements, and / or system enhancements.
• Acts as a subject matter expert to team members and consults on complex or escalated issues; Trains and mentors lower-level team members on department concepts, practices, procedures, policies, processes and / or issue resolution.
• Creates and maintains current desk level procedures (DLPs), reporting, training, and audit tools to support the success of audits and exams.
• Provides guidance on monitoring audit / exam activities in order to meet compliance standards, contractual obligations, and / or performance guarantees with clients and legislative and regulatory bodies; Analyzes policies, procedures, and business process modifications for compliance.
• Serves as the primary point of contact for delegated credentialing entities, internal Regulatory, Ethics and Compliance partners, external auditors, regulators, examiners, and internal stakeholders, representing the company with professionalism and accuracy.
• Oversees the review and assessment of the delegated credentialing agreement, credentialing files submitted by delegated entities to ensure compliance with contractual and regulatory requirements prior to delegation (pre-delegated audits) and throughout the contract period (annual delegated audits).
• Issues and tracks corrective actions related to credentialing audit findings, collaborating with delegated entities and internal partners to ensure timely and effective resolution.
• Designs and enhances audit tools, dashboards, and reporting mechanisms to proactively identify and mitigate risks associated with delegated credentialing.
• Monitors and interprets legislative, regulatory, and accreditation changes (e.g., NCQA, CMS, state regulations) related to credentialing delegation to assess potential impacts. Advises leadership on compliance readiness, regulatory trends, and risks specifically related to delegated credentialing.

QUALIFICATIONS

Minimum Qualifications

Knowledge, Skills, Abilities

Base Pay Information

The national base pay range at the end is a good-faith estimate of what Delta Dental may pay for new hires. Actual pay may vary based on Delta Dental's assessment of the candidate's knowledge, skills, abilities (KSAs), related experience, education, certifications and ability to meet required minimum job qualifications. Other factors impacting pay include prevailing wages in the work location and internal equity.

Pay Grade 19. $63,700 - $133,500

ADDITIONAL INFORMATION

Behind the smile! We are dedicated to safeguarding the health and financial stability of our employees and their loved ones. This commitment extends beyond the workplace to foster personal growth and holistic wellbeing. Our life-changing rewards package includes :

Fair Chance Ordinances and Criminal Background Considerations

This position requires that the applicant undergo a background check. Qualified applicants with arrest or conviction records will be considered for employment in accordance with any applicable federal, state or local laws, including, but not limited to, the California Fair Chance Act, the Los Angeles County Fair Chance Ordinance, the City of Los Angeles Fair Chance Initiative for Hiring Ordinance, the San Francisco Fair Chance Ordinance, and / or New York Corrections Law Article 23-A.

#LI-Hybrid

ABOUT THE TEAM

Delta Dental Ins. is an equal opportunity employer and is committed to providing a professional work environment free from discrimination and harassment. Individuals seeking employment at Delta Dental are considered without regard to race, ethnicity, color, age, sex, religion, national origin, ancestry, pregnancy, sexual orientation, gender identity, gender expression, genetic information, actual or perceived physical or mental disability, registered domestic partner status, caregiver status, marital status, veteran or military status, citizenship status, or any other legally protected category. Delta Dental is committed to providing equal employment opportunities to all employees and applicants for employment. Accordingly, we have adopted and maintain an Equal Employment Opportunity Policy, Harassment-Free Work Environment Policy, and Respectful Workplace policies and will not tolerate violations of these policies.

Unfortunately, our Delta Dental Enterprise is unable to hire individuals residing in Alaska, Hawaii, Maine, Nebraska, New Hampshire, North Dakota, Oklahoma, Vermont, West Virginia, Wyoming, Washington DC, Puerto Rico or other US Territories or outside of the United States at this time.