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Credentialing Auditor Jobs (NOW HIRING)

WellSpan Health

Credentialing Auditor

York, PA

General Summary Performs routine and targeted audits of credentialing and enrollment work products. Validates documentation and data integrity, identifies compliance gaps, and supports corrective ...

WellSpan Health

Credentialing Auditor

York, PA · On-site

General Summary Performs routine and targeted audits of credentialing and enrollment work products. Validates documentation and data integrity, identifies compliance gaps, and supports corrective ...

CommonSpirit Health

Three (3) years experience in a Health Care Plan Credentialing / Provider Relations and / or auditing setting, or Health Care Enrollment Preferred * Bachelor's degree * Certified Provider ...

State of Michigan

Senior Auditor (Auditor 12)

Lansing, MI · On-site

$31.95 - $45.78/hr

View the Auditor 12 position description. View the Auditor Job Specification. Treasury Careers ... credentials evaluated or converted into U.S. educational equivalents unless the degree has been ...

New England Baptist Hospital

The Credentialing Coordinator is responsible for assisting in the planning, implementation and ... Prepare initial and reappointment files for auditing and committee review. * Pursue incomplete and ...

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How much do credentialing auditor jobs pay per hour?

As of Jun 9, 2026, the average hourly pay for credentialing auditor in the United States is $24.36, according to ZipRecruiter salary data. Most workers in this role earn between $19.23 and $27.64 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Credentialing Auditor position, and why are they important?

To thrive as a Credentialing Auditor, you need a solid understanding of healthcare regulations, credentialing processes, and auditing standards, often supported by experience in healthcare administration or compliance. Familiarity with credentialing management software, databases, and knowledge of compliance policies like NCQA or Joint Commission standards is typically required. Strong attention to detail, critical thinking, and effective communication skills help auditors excel in this role. These competencies are crucial to ensuring accuracy, regulatory compliance, and the integrity of health provider credentialing systems.

What are the most common challenges faced by Credentialing Auditors, and how can they be managed?

Credentialing Auditors often encounter challenges such as navigating complex regulatory requirements, identifying inconsistencies in documentation, and keeping up with frequent changes in compliance standards. Managing these obstacles requires strong organizational skills and a proactive approach to staying current with industry updates and best practices. Auditors may rely heavily on established checklists, ongoing professional training, and open communication with credentialing teams to ensure thorough and accurate reviews. Leveraging these strategies helps maintain compliance and minimizes delays in provider approvals, making the role vital to healthcare organizations.

What is a Credentialing Auditor job?

A Credentialing Auditor is responsible for reviewing and verifying the credentials of healthcare providers to ensure compliance with industry, regulatory, and organizational standards. They audit provider documentation, licensure, certifications, and professional history to confirm accuracy and completeness. Their role helps maintain high-quality patient care by ensuring that only qualified professionals are credentialed. Credentialing Auditors often work with healthcare organizations, insurance companies, and accreditation agencies to uphold regulatory requirements.

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Credentialing Auditor jobs near you
Infographic showing various Credentialing Auditor job openings in the United States as of June 2026, with employment types broken down into 25% Locum Tenens, 3% As Needed, 20% Full Time, 19% Part Time, 1% Temporary, and 32% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $50,665 per year, or $24.4 per hour.
Credentialing Auditor

Credentialing Auditor

WellSpan Health

York, PA

Full-time

Medical, Retirement, PTO

Posted 6 days ago

WellSpan Health rating

7.5

Company rating: 7.5 out of 10

Based on 287 frontline employees who took The Breakroom Quiz

223rd of 870 rated healthcare providers

Job description

General Summary

Performs routine and targeted audits of credentialing and enrollment work products. Validates documentation and data integrity, identifies compliance gaps, and supports corrective actions to strengthen quality, standardization, and audit readiness.

Qualifications
Minimum Education:

  • High School Diploma or GED Required
  • Associates Degree or higher in a related field Preferred

Work Experience:

  • 3 years Experience in provider credentialing, medical staff services, provider enrollment, or related healthcare administrative operations Required
  • Quality assurance or audit experience in credentialing/enrollment environments Preferred

Licenses:

  • Certified Provider Credentialing Specialist Upon Hire Preferred or
  • Certified Professional Medical Services Management Upon Hire Preferred

Knowledge, Skills, and Abilities:

  • Strong attention to detail and ability to manage multiple priorities while meeting deadlines
  • Proficiency with Microsoft Office (Outlook, Excel, Word) and ability to learn credentialing/enrollment systems
  • Effective written and verbal communication skills with providers, payers, and internal stakeholders
  • Ability to interpret policies, procedures, and payer/agency requirements and apply them consistently
  • Demonstrated discretion and ability to maintain confidentiality of sensitive information
  • Ability to apply audit methodology, document findings clearly, and communicate issues with diplomacy and precision

Benefits Offered:

  • Comprehensive health benefits
  • Retirement savings plan
  • Paid time off (PTO)
  • Education assistance
  • Financial education and support, including DailyPay
  • Expanded Paid Parental Leave

For additional details: Benefits & Incentives | WellSpan Careers (joinwellspan.org)

Duties and Responsibilities
Essential Functions:

  • Conducts routine and targeted audits of credentialing and enrollment files to verify completeness, documentation, and adherence to established standards.
  • Validates primary source verification evidence, required queries, decision documentation, and file timeliness against policy and checklist requirements.
  • Audits delegated credentialing-related work products (e.g., roster files and supporting documentation) to ensure accuracy and completeness prior to submission.
  • Reconciles provider data across systems (e.g., Cactus, and internal trackers) and identifies discrepancies requiring correction.
  • Documents audit findings, assigns issue categories, and communicates results to operational teams and leadership.
  • Tracks corrective actions, verifies completion, and performs re-audits as needed to confirm sustained compliance.
  • Maintains audit tools (checklists, sampling logs, scorecards) and produces periodic audit reports and trend summaries.
  • Partners with credentialing and enrollment staff to provide feedback and support training opportunities based on audit outcomes.
  • Supports internal and external audits by compiling documentation and responding to information requests.

Common Expectations:

  • Maintains established policies and procedures, objectives, quality assessment and safety standards.
  • Maintains professional growth and development.
  • Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

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