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SalaryOverview:
Summary: The Credentialing Delegated Specialist is an administrative role with responsibility for delegated audits, monthly submissions, updating policy & procedures, and confirming compliance with NCQA standards and any other applicable industry standards for provider credentialing and enrollment. Accountable for delegated credentialing for all markets and products.
Qualifications:
Education: Some college coursework is desired.
Experience1 or more years’ experience in provider credentialing or related area is required.
Credentialing Delegated Specialist
Summary: The Credentialing Delegated Specialist is an administrative role with responsibility for delegated audits, monthly submissions, updating policy & procedures, and confirming compliance with NCQA standards and any other applicable industry standards for provider credentialing and enrollment. Accountable for delegated credentialing for all markets and products.
Benefits:
- PTO
- Sick days
- Paid Holidays
- Health, Dental, Vision Insurance
- 401(k)
Remote Position
Job Responsibilities / Functions
- Responsible for compliance with NCQA delegated credentialing and any other applicable industry standard for provider credentialing and enrollment.
- Oversees all delegated provider credentialing functions to ensure compliance.
- Recommends and implements changes in policies and procedures to stay up to date with industry standards.
- Services as company subject matter expert in delegated credentialing requirements, processes, and procedures
- Presents results of health plan audits to Management
- Communicates with groups regarding delegation status, assists with development of corrective action plans, and breach of the delegated credentialing agreements.
- Prepares pre-delegated annual assessment audits, sending pre and post audit letters and communications.
- Investigates and processes applications for new and previously rejected or terminated practitioners in delegated groups.
- Monthly, quarterly submissions of new, terms or changes for locations & providers to delegated groups (13 delegated agreements)
- Performs pre-delegated audits and annual assessment audits to ensure delegated entities are compliant with policies and procedures.
- Develops & monitors reports on delegated activity.
- Responsible for routine internal monitoring and auditing of compliance risks, prompt response to compliance issues as they are raised, investigation of potential compliance problems as identified during self-evaluation and audits, correction of such problems promptly and thoroughly to reduce the potential for recurrence.
- Works with Clinical Operations, Compliance, Legal and Revenue Cycle Manager to support overall business functions.
- Collaborates with IT to ensure security with maintenance of provider information and health plan information.
- Works collaboratively with other Delegated Confluent Health Partners (PTPN)
- Assists management with projects as needed.
Qualifications:
Job Requirements
Education: Some college coursework is desired.
Experience1 or more years’ experience in provider credentialing or related area is required.
Skills & Knowledge
- Must be self-motivated and detail oriented. Great at follow through.
- Excellent multi-tasker in a fast-paced environment.
- Excellent interpersonal and communication skills.
- Excellent organizational skills and proven ability to collaborate with different constituencies and manage tasks to ensure deadlines are met and a quality product is produced.
- AmaZing! customer service ethic and high expectations for quality.
- Proficient using online software applications as well as the latest versions of Google Apps, Microsoft Word, Excel, and PowerPoint.
- Experience with OneView is a plus!
