• Conduct credentialing audits in accordance with regulatory, contractual, and industry standards • Execute delegated credentialing audits using established methodologies, sampling criteria, and documentation standards to ensure accuracy, consistency, and regulatory readiness. • Evaluate delegated entities’ compliance with CMS, DMHC, NCQA, federal/state credentialing requirements, and Alignment’s contractual standards. • Maintain organized, complete, and audit-ready documentation to support regulatory reviews, accreditation audits, and internal oversight. • Ensure all audit activities align with the enterprise audit strategy set by the Manager, Audit Administration. • Engage delegated provider organizations to correct deficiencies and improve performance • Communicate audit scope, expectations, and timelines clearly to delegated provider organizations throughout the audit lifecycle. • Provide delegates with clear explanations of audit findings, including root causes, compliance gaps, and potential operational impacts. • Support delegated entities in understanding credentialing requirements and expectations for corrective actions. • Promote productive and professional working relationships to foster transparency, collaboration, and continuous improvement. • Perform risk assessment and prioritize audits • Assist in identifying high-risk focus areas by reviewing prior audit results, monitoring data, and operational issues related to credentialing performance. • Recommend audit prioritization based on risk severity, regulatory sensitivity, and emerging compliance trends. • Provide input to refine audit scopes and schedules in alignment with the Manager’s risk-based audit and monitoring strategy. • Escalate emerging risks or irregular credentialing issues to the Manager, Audit Administration for strategic review and inclusion in future audit planning. • Validate corrective actions for credentialing compliance • Review and validate Corrective Action Plans (CAPs) submitted by delegated entities, ensuring remediation fully addresses identified credentialing deficiencies. • Assess evidence such as updated credentialing files, process changes, workflow revisions, and policy updates to confirm compliance with regulatory and contractual standards. • Track CAP progress and ensure follow-up activities are completed and documented according to departmental requirements. • Escalate irregular, incomplete, or stalled CAPs to the Manager, Audit Administration to support timely issue resolution. • Report credentialing audit findings to facilitate organizational awareness • Prepare clear, concise, and well-structured audit summaries highlighting key risks, deficiencies, and improvement opportunities across delegated credentialing practices. • Contribute to department-standard reporting tools, dashboards, and audit documentation used for leadership and cross-functional communication. • Partner with Delegate Performance, Clinical Operations, Quality, Compliance, and other internal teams to ensure findings are understood and actionable. • Support preparation of materials for internal committees, regulatory bodies, and enterprise risk-management forums. • Manage multiple credentialing audits simultaneously, ensuring adherence to timelines, scope, and quality standards. • Monitor credentialing-related data to identify emerging trends, potential non-compliance, and areas requiring targeted review. • Contribute subject-matter insights during training or education sessions for delegated entities to reinforce credentialing expectations and reduce recurring deficiencies. • Support compilation of documentation and evidence for CMS, NCQA, or other regulatory audits. • Perform additional responsibilities and projects as assigned.