CrawlJobs Logo

Payer Delegation and Compliance Specialist

anderscpa.com Logo

Anders Minkler Huber & Helm LLP

Location Icon

Location:
United States , St. Louis ▼

Category Icon
Category:
-

Job Type Icon

Contract Type:
Not provided

Salary Icon

Salary:

68500.00 - 81500.00 USD / Year
Save Job
Save Icon
Apply Position

Job Description:

The Payer Delegation and Compliance Specialist at A5 Healthcare serves a critical role in ensuring that delegated healthcare tasks and responsibilities are executed in compliance with NCQA regulatory standards and organizational policies for the Primoris Independent Physician Association (IPA). This position is responsible for delegated credentialing, compliance monitoring, performance assessment, file audits and analysis, and improving the delegation processes to enhance client quality and operational efficiency. Communication and accountability in delegated functions are essential to meeting NCQA CR accreditation requirements.

Job Responsibility:

  • Payer Delegation: NCQA standards (understand and identify changes necessary to comply with NCQA standards)
  • CAQH Application retrieval and review
  • File Audit and Analysis for inappropriate documentation and updates to credentialing information
  • Conduct qualitative analysis of inappropriate documentation and updates
  • Payer Rosters must be completed in accordance with A5’s policy and procedures
  • Credentialing Information Integrity
  • Policy and procedure (writing and updating in accordance with payer and NCQA standards)
  • Trouble shoot and problem solve implementation challenges related to NCQA standards, policy, and procedures
  • Evolution of system controls requirements
  • Team Collaboration: Communicate regularly with the non-delegated provider enrollment and CVO teams
  • Support teamwork balancing by assisting in complex case management and troubleshooting
  • Collaborate cross-functionally with internal stakeholders such as compliance, provider relations, and operations
  • General Responsibilities: Maintain in-depth knowledge of evolving payer policies, credentialing regulations, and accreditation standards
  • Analyze data and produce reports on credentialing metrics and trends
  • Participate in continuous improvement initiatives and credentialing software optimization
  • Promote a collaborative, high-performance culture in a fully remote or hybrid team environment

Requirements:

  • Proven leadership ability and experience mentoring or training junior staff
  • Advanced understanding of CVO credentialing workflows, payer delegation requirements, and NCQA regulatory compliance
  • High-level organizational and problem-solving skills with keen attention to detail
  • Excellent written and verbal communication
  • capable of handling sensitive issues with professionalism
  • Proficient in credentialing and enrollment systems, with strong Excel and Microsoft Office Suite skills
  • Self-directed, accountable, and capable of managing priorities in a fast-paced remote environment
  • Associate’s degree required
  • Bachelor’s degree in healthcare administration or a related field preferred
  • Minimum 5 years of experience in delegation and compliance, payer enrollment or healthcare credentialing, including experience with NCQA, URAC, and CMS standards
  • Certification as a NAMSS Certified Provider Enrollment Specialist (CPES) is strongly preferred
  • Applicants must be located within the Greater St. Louis, MO area or Tulsa, OK
What we offer:
  • Work Flex program which gives you the opportunity to work at our Chesterfield office, our Downtown St. Louis office, remotely, adopt a hybrid approach or even switch between these options as you prefer
  • Professional development opportunities
  • Benefits that directly impact mental, physical and financial wellness

Additional Information:

Job Posted:
January 18, 2026

Employment Type:
Fulltime
Work Type:
Remote work
Icon
Anders Minkler Huber & Helm LLP - All Job Offers
Job Link Share:
Copy Link Icon
Facebook Icon Twitter Icon LinkedIn Icon
PREMIUM
More languages and countries
+ Unlock 31698 hidden job offers
Languages
English Čeština Deutsch Ελληνικά Español Français +15
Countries
United States United Kingdom India Canada Australia +
See plans
Plans from $2.99 / month

Looking for more opportunities? Search for other job offers that match your skills and interests.

Briefcase Icon

Similar Jobs for Payer Delegation and Compliance Specialist

Provider Enrollment Specialist

The Provider Enrollment Specialist ensures seamless plan enrollment (initial and...
Location
Location
United States , St. Louis
Salary
Salary:
21.00 - 27.00 USD / Hour
anderscpa.com Logo
Anders Minkler Huber & Helm LLP
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Associate degree, preferred
  • High School diploma or GED required
  • 3-5 years of experience in payer enrollment
  • Strong organizational and time management skills, with the ability to manage multiple tasks and meet deadlines
  • Excellent attention to detail and accuracy in data entry and record-keeping
  • Effective communication skills, both written and verbal, with the ability to interact professionally with providers, staff and external entities
  • Ability to work independently and as part of a team, demonstrating flexibility and adaptability
  • Strong problem-solving skills, with the ability to identify and resolve issues promptly and effectively
  • Knowledge of healthcare regulations and compliance requirements
  • Familiarity with NCQA, URAC, and CMS standards
Job Responsibility
Job Responsibility
  • Process and submit initial provider applications, revalidations, and renewal applications in compliance with NCQA, URAC, and CMS accreditation standards
  • Perform thorough and accurate data entry and verification of provider information into credentialing databases
  • Conduct timely follow-up on missing or incomplete information with the provider, client, or team lead responsible for a provider file to ensure prompt and efficient provider enrollment
  • Assist in the preparation and submission of required documentation for provider enrollment and credentialing to include delegation rosters
  • Coordinate with internal staff and external entities to resolve issues related to provider enrollment and credentialing
  • Monitor and track the status of provider applications, payer directories, conducting regular follow-up with health plans until verification of completion is received from each payor
  • Support the enrollment and delegation team with various tasks as needed
What we offer
What we offer
  • Work Flex program which gives you the opportunity to work at our Chesterfield office, our Downtown St. Louis office, remotely, adopt a hybrid approach or even switch between these options as you prefer
  • Professional development opportunities
  • Benefits that directly impact mental, physical and financial wellness
  • Fulltime
Read More
Arrow Right

Audit Senior

A fast-growing Top 40 accountancy group is looking to appoint an Audit Senior / ...
Location
Location
United Kingdom , Nuttall, Bury
Salary
Salary:
38000.00 - 50000.00 GBP / Year
socialvalueportal.com Logo
Social Value Portal Ltd
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • ACA / ACCA qualified or finalist
  • Previous audit experience within an accountancy practice environment
  • Strong communication skills and confident dealing directly with clients
  • Able to manage multiple assignments and prioritise effectively
  • Enjoys working as part of a collaborative and supportive team
  • Ambitious and keen to continue progressing professionally
Job Responsibility
Job Responsibility
  • Lead audits from planning through to completion for a varied portfolio of clients
  • Prepare and review statutory accounts under UK GAAP
  • Build strong client relationships and act as a key point of contact throughout the audit process
  • Support and mentor junior members of the team, reviewing work and assisting with development
  • Work closely with Managers and Partners on wider advisory projects and client matters
  • Identify opportunities to improve client processes and add value beyond compliance
  • Assist with budgeting, workflow management and meeting deadlines across multiple assignments
What we offer
What we offer
  • Hybrid and flexible working model
  • 25+ days holiday plus bank holidays
  • Birthday day off
  • Enhanced family-friendly policies
  • Fully funded professional development and structured progression plans
  • Mentoring and leadership development programmes
  • Modern office environment with collaborative workspaces
  • Regular socials, wellbeing initiatives and team events
  • Employee benefits portal with discounts across major brands
  • Volunteer day to support charities and community projects
  • Fulltime
Read More
Arrow Right

Pharmacy Technician

We're building a world of health around every individual — shaping a more connec...
Location
Location
United States , North Andover
Salary
Salary:
17.00 - 27.00 USD / Hour
https://www.cvshealth.com/ Logo
CVS Health
Expiration Date
July 04, 2026
Flip Icon
Requirements
Requirements
  • Must comply with any state board of pharmacy requirements or laws governing the practice of pharmacy, which includes but is not limited to, age, education, and licensure/certification
  • If the state board of pharmacy does not address or mandate a minimum age requirement, must be at least 16 years of age
  • If the state board of pharmacy does not address or mandate a minimum educational requirement, must have a high school diploma or equivalent, or be actively enrolled in high school or high school equivalency program
  • State-level licensure and national certification requirements vary by state
Job Responsibility
Job Responsibility
  • Living our purpose by following all company Standard Operating Procedures at each workstation to help our Pharmacists manage and improve patient health
  • Following pharmacy workflow procedures at each pharmacy workstation (i.e., production, pick-up, drive-thru, and drop-off) for safe and accurate prescription fulfillment
  • Contributing to positive patient experiences by showing empathy and genuine care
  • Completing basic inventory activities, as permitted by law, and as directed by the pharmacy leadership team
  • Contributing to a high-performing team, embracing a growth mindset, and being receptive to feedback
  • Remaining flexible for both scheduling and business needs, while contributing to a safe, inclusive, and engaging team dynamic
  • Understanding and complying with all relevant federal, state, and local laws, regulations, professional standards, and ethical principles
  • Delivering additional patient health care services (e.g., immunizations, point-of-care testing, and voluntarily staffing offsite clinics), where allowable by law and supported by required training and certification
What we offer
What we offer
  • dental
  • vision
  • wellness resources
  • employee discounts
  • access to certain voluntary benefits
  • Parttime
Read More
Arrow Right

Product Development and Sustainment Programme Manager

Engineered to Protect, that’s our promise, we protect what matters - our nations...
Location
Location
United Kingdom , Barnstaple
Salary
Salary:
75000.00 GBP / Year
socialvalueportal.com Logo
Social Value Portal Ltd
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Hands-on experience with project management tools (e.g., Microsoft Project, risk registers) and professional qualifications such as APM, PMI, or PRINCE2
  • Proven experience managing complex product or systems development through the full lifecycle in defence or similarly regulated environments
  • Deep knowledge of all phases of project/programme delivery – from inception and planning through execution, monitoring, and closure – within an Engineering Delivery context
  • Strong financial and commercial acumen, including budgeting, forecasting, Earned Value Management (EVM), and supplier/subcontractor management
  • Expertise in risk and opportunity management, configuration management, and change control processes
  • Excellent communication and influencing skills, with demonstrated ability to manage stakeholders, resolve conflicts, and lead effective change
Job Responsibility
Job Responsibility
  • Define and deliver product development programmes, which may come from customer-funded and PV initiatives, ensuring alignment with strategic goals
  • Own outcomes for scope, budget, quality, and timescales, monitoring progress and initiating corrective actions
  • Act as the primary customer and stakeholder interface, maintaining constructive relationships with customers, suppliers, and internal teams
  • Identify and control Key Interface Dependencies (KIDs) supporting Customer Project Delivery
  • Provide strong leadership, fostering team engagement, collaboration, and focus on common goals
  • Identify, manage, and resolve risks, issues, and opportunities, leading problem-solving and contingency planning
  • Ensure compliance with defence standards, security protocols, and champion process improvement in line with best practice
  • Coordinate the cross-functional Integrated Project Team (IPT) to achieve milestones and product releases
What we offer
What we offer
  • Hybrid/flexible working arrangements
  • 25 days’ annual leave, plus buy and sell
  • Up to 16 days flexi leave accrual
  • Half day Fridays
  • Reservists in the Armed Forces receive special paid leave
  • Private medical health insurance & Employee Assistance Program
  • All Staff Bonus
  • Group Pension Plan of up to 7% employer contribution
  • Cycle to work scheme
  • Wellbeing Centre
  • Fulltime
Read More
Arrow Right

Gen Ai Tech Engineering Lead - Senior Vice President

This role is for an innovative Generative AI Engineer to drive the adoption of L...
Location
Location
India , Pune
Salary
Salary:
Not provided
https://www.citi.com/ Logo
Citi
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Deep hands-on experience in engineering and executing enterprise solutions that scale effectively
  • Fluency in at least two programming languages, with a strong preference for Python and Java. Proficiency in Javascript/Typescript and Golang is also highly valued
  • Strong understanding of Language Models (LLMs), transformers, agentic frameworks, vector stores, and search algorithms
  • Experience with relevant frameworks such as Spring (AI, Boot, Core, etc.), Flask, LangChain, LangGraph, ADK, and MLFlow
  • Proficiency in database technologies, such as Oracle, Postgres, or MongoDB
  • Experience with messaging and integration platforms like Kafka or JMS/MQ
  • UI development skills with technologies such as React JS or StreamLit
  • Experience designing and implementing REST and WebSocket APIs
  • Familiarity with one of the major cloud platforms including AWS, GCP, or Azure
  • Strong knowledge of infrastructure tools, including Docker, Kubernetes, Terraform, and Helm
Job Responsibility
Job Responsibility
  • Contribute significantly to both engineering and research initiatives within the Generative AI domain
  • Adopt a product-focused approach, ensuring the development of robust, scalable, and user-friendly solutions
  • Thrive in a fast-paced environment by continuously testing, learning, and tackling cutting-edge problems
  • Actively engage in pair programming, promote lean methodologies, and streamline processes by removing unnecessary bureaucracy
  • Prioritize rapid delivery and iterative development, demonstrating adaptability and a willingness to pivot rather than pursuing a perfect upfront solution
  • Develop foundational components and mature technology capabilities in Artificial Intelligence (AI) and Large Language Models (LLMs)
  • Drive the enterprise-wide adoption and successful integration of Generative AI solutions
  • Demonstrate strong problem-solving capabilities and a proactive learning mindset, continuously acquiring new skills
  • Exhibit excellent communication and collaboration skills, effectively engaging with diverse stakeholders
  • Be adaptable and resourceful in navigating complex technical and organizational challenges
  • Fulltime
Read More
Arrow Right

Store Associate

We’re building a world of health around every individual — shaping a more connec...
Location
Location
United States , Marion
Salary
Salary:
15.00 - 19.00 USD / Hour
https://www.cvshealth.com/ Logo
CVS Health
Expiration Date
June 19, 2026
Flip Icon
Requirements
Requirements
  • At least 16 years of age
  • Remaining upright on the feet, particularly for sustained periods of time
  • Lifting and exerting up to 35 lbs of force occasionally, up to 10 lbs of force frequently, and a negligible amount of force regularly to move objects to and from, including overhead lifting
  • Visual Acuity - Having close visual acuity to perform activities such as: viewing a computer terminal, reading, visual inspection involving small parts/details
Job Responsibility
Job Responsibility
  • Providing differentiated customer service by anticipating customer needs, demonstrating compassion and care in all interactions, and actively identifying and resolving potential service issues
  • Focusing on the customer by giving a warm and friendly greeting, maintaining eye contact and offering help locating additional items, when needed
  • Accurately perform cashier duties - handling cash, checks and credit card transactions with precision while following company policies and procedures
  • Maintaining the sales floor by restocking shelves, checking in vendors, updating pricing information and completing inventory management tasks as directed by store manager
  • Supporting opening and closing store activities, when needed
  • Providing customer support to all departments, including photo and beauty, ensuring departments are fully stocked and operational while remaining current with all updated services and tools
  • Assisting pharmacy personnel when needed, including working regular shifts in the pharmacy as part of opportunities for growth and career development
  • Embracing and advocating for new CVS services and loyalty programs that support our purpose of helping people on their path to better health
What we offer
What we offer
  • dental
  • vision
  • wellness resources
  • employee discounts
  • access to certain voluntary benefits
  • other programs
  • Parttime
Read More
Arrow Right

Senior Software Engineer Staff - Clearance Required

This position is participating in our External Referral Program. If you know som...
Location
Location
United States , Baltimore
Salary
Salary:
Not provided
tietalent.com Logo
TieTalent
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Fourteen (14) years experience as a SWE in programs and contracts of similar scope, type, and complexity is required. Bachelor’s degree in Computer Science or related discipline from an accredited college or university is required. Four (4) years of additional SWE experience on projects with similar software processes may be substituted for a bachelor’s degree
  • Candidate must possess active security clearance with a polygraph.
Job Responsibility
Job Responsibility
  • Analyze user requirements to derive software design and performance requirements
  • Design and code new software or modify existing software to add new features
  • Integrate existing software into new or modified systems or operating environments
  • Write or review software and system documentation
  • Serve as team lead at the level appropriate to the software development process being used on any particular project
  • Design or implement complex database or data repository interfaces/queries
  • Develop or implement algorithms to meet or exceed system performance and functional standards
  • Assist with developing and executing test procedures for software components
  • Develop software solutions by analyzing system performance standards, confer with users or system engineers
  • analyze systems flow, data usage and work processes
What we offer
What we offer
  • World‑class resources
  • mentorship
  • continuous learning
  • competitive compensation
  • comprehensive benefits
  • supportive work‑life balance
  • culture that values innovation, integrity, and collaboration
  • referral bonus of $3,000
  • Fulltime
Read More
Arrow Right

Headteacher

Outcomes First Group is a leading provider of world-class education. We believe ...
Location
Location
United Kingdom , North West
Salary
Salary:
85000.00 GBP / Year
socialvalueportal.com Logo
Social Value Portal Ltd
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Proven leadership experience as a Headteacher or senior school leader
  • A strong track record of delivering high-quality educational outcomes
  • Strategic thinker with the ability to lead, influence and manage change
  • An inspirational and authentic leader with excellent communication skills
  • Ability to build trusting relationships and lead high-performing teams
  • Sound understanding of school operations, compliance and safeguarding requirements
  • Resilient, adaptable and forward-thinking approach to leadership
  • NPQH (completed or actively working towards)
  • Experience or strong knowledge of ISI and/or Ofsted frameworks
Job Responsibility
Job Responsibility
  • Providing strategic and operational leadership that fosters a positive, high-performing school culture
  • Leading the ongoing development of your school, ensuring strong academic outcomes and a rich, inclusive pupil experience
  • Championing excellence in teaching, learning and assessment across all ages and abilities
  • Building, developing and motivating a cohesive staff team, aligned to clear values and high expectations
  • Ensuring the highest standards of safeguarding, wellbeing and pastoral care
  • Overseeing effective school operations, including financial sustainability and resource management
  • Engaging confidently and professionally with parents, colleagues and the wider community
  • Contributing to the wider growth and development of the organisation, including future opportunities and new provision
What we offer
What we offer
  • Opportunities for career progression and leadership development
  • Join a culture that values innovation, initiative and high standards
  • Have the opportunity to shape and lead schools at a pivotal stage of growth
  • Fulltime
Read More
Arrow Right