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Form of workJob Number: 5347
Position Title:Delegation Oversight, Sr. Credentialing Specialist
External Description:
Position Summary:
The Delegation Oversight Sr. Credentialing Specialist is responsible for assisting in all aspects of the Delegation Oversight Department's audit and monitoring program of contracted entities delegated for credentialing. The Sr. Credentialing Specialist is responsible for ensuring delegated entities are compliant with Medicare Advantage, NCQA, State and contract requirements.
General Duties/Responsibilities (May include but are not limited to):
Responsible for retrieving and reviewing the HICE Credentialing Shared Audit Policy Team audit results for Alignment's delegated entities that participate in the program.
Communicates audit results and issues corrective action requests (CARs) when deficiencies are reported by the HICE Credentialing Shared Audit Policy Team audits.
Ensures timely receipts of CAR responses and follows up with outstanding requests.
Reviews corrective action plan responses to ensure the root cause, corrective actions and remediations will prevent the same issue from recurring.
Maintains audit file documentation and SharePoint tracking.
Assists the DO Credentialing Auditor with pre-delegation reviews.
Participates in the HICE Credentialing Shared Audit Policy Team meetings.
Assist with developing and maintaining credentialing audit tools, policies and reporting templates.
Assist the DO Credentialing Auditor with the distribution of quarterly credentialing reporting requirements and education, tracks receipts of attestations, follow-up with non-responders.
Assist with departmental reporting of the credentialing oversight activities, as needed.
Assists and/or participates in CMS and other regulatory audits, as needed.
Perform other duties as assigned.
Supervisory Responsibilities
N/A
Minimum Requirements:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Minimum Experience:
2-3 years' experience in the field of credentialing in a healthcare environment
1-2 years' audit experience in a Delegation Oversight, compliance, or other Medicare Advantage plan oversight area
Education/Licensure:
High School Diploma or equivalent, some college a plus
Credentialing Certificate (CPCS) a plus
Other:
Excellent written and verbal communication skills.
Extremely detail oriented.
Proven follow-up skills
Proficient in Microsoft Office, knowledge of other systems preferred.
Knowledge of Medicare Application processing
Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
City: Orange
State: California
Location City: Orange
Location State: California
Community / Marketing Title:Delegation Oversight, Sr Credentialing Specialist
Company Profile:
Alignment Health was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.
By becoming a part of the Alignment Health team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.
EEO Employer Verbiage:
Alignment requires all new hires to follow local and/or state requirements regarding the COVID-19 vaccine and booster. If applicable, proof of vaccination and booster will be required as a condition of employment subject to legal exemptions. This policy, which Alignment reserves the right to modify, is part of Alignment's ongoing efforts to ensure the safety and well-being of its staff and community and to support public health efforts.
Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.
If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact [email protected].
*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email [email protected].
Position Title:Delegation Oversight, Sr. Credentialing Specialist
External Description:
Position Summary:
The Delegation Oversight Sr. Credentialing Specialist is responsible for assisting in all aspects of the Delegation Oversight Department's audit and monitoring program of contracted entities delegated for credentialing. The Sr. Credentialing Specialist is responsible for ensuring delegated entities are compliant with Medicare Advantage, NCQA, State and contract requirements.
General Duties/Responsibilities (May include but are not limited to):
Responsible for retrieving and reviewing the HICE Credentialing Shared Audit Policy Team audit results for Alignment's delegated entities that participate in the program.
Communicates audit results and issues corrective action requests (CARs) when deficiencies are reported by the HICE Credentialing Shared Audit Policy Team audits.
Ensures timely receipts of CAR responses and follows up with outstanding requests.
Reviews corrective action plan responses to ensure the root cause, corrective actions and remediations will prevent the same issue from recurring.
Maintains audit file documentation and SharePoint tracking.
Assists the DO Credentialing Auditor with pre-delegation reviews.
Participates in the HICE Credentialing Shared Audit Policy Team meetings.
Assist with developing and maintaining credentialing audit tools, policies and reporting templates.
Assist the DO Credentialing Auditor with the distribution of quarterly credentialing reporting requirements and education, tracks receipts of attestations, follow-up with non-responders.
Assist with departmental reporting of the credentialing oversight activities, as needed.
Assists and/or participates in CMS and other regulatory audits, as needed.
Perform other duties as assigned.
Supervisory Responsibilities
N/A
Minimum Requirements:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Minimum Experience:
2-3 years' experience in the field of credentialing in a healthcare environment
1-2 years' audit experience in a Delegation Oversight, compliance, or other Medicare Advantage plan oversight area
Education/Licensure:
High School Diploma or equivalent, some college a plus
Credentialing Certificate (CPCS) a plus
Other:
Excellent written and verbal communication skills.
Extremely detail oriented.
Proven follow-up skills
Proficient in Microsoft Office, knowledge of other systems preferred.
Knowledge of Medicare Application processing
Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
City: Orange
State: California
Location City: Orange
Location State: California
Community / Marketing Title:Delegation Oversight, Sr Credentialing Specialist
Company Profile:
Alignment Health was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.
By becoming a part of the Alignment Health team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.
EEO Employer Verbiage:
Alignment requires all new hires to follow local and/or state requirements regarding the COVID-19 vaccine and booster. If applicable, proof of vaccination and booster will be required as a condition of employment subject to legal exemptions. This policy, which Alignment reserves the right to modify, is part of Alignment's ongoing efforts to ensure the safety and well-being of its staff and community and to support public health efforts.
Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.
If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact [email protected].
*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email [email protected].
