Information Technology

Employment TYPE

Contract

LOCATION

Mason, Ohio

DATE POSTED

April 8, 2019

INDUSTRY

Information Technology

POSITION(S)

1

SALARY

Negotiable

Job# J441

Credentialing Coordinator

About The Opportunity

The Delegation Credentialing Analyst serves as the main resource to administer the delegated provider credentialing and re-credentialing processes and ensure vendors/partners/providers are compliant with credentialing guidelines.

Job Description

  • The Delegation Credentialing Analyst serves as the main resource to administer the delegated provider credentialing and re-credentialing processes and ensure vendors/partners/providers are compliant with credentialing guidelines.
  • MAJOR DUTIES AND RESPONSIBILITIES :
  • Defines the delegation of credentialing processes/procedures for the organization which includes adherence to NCQA standards, State, Federal and other applicable guidelines
  • Leads the overall delegation activities for provider credentialing and re-credentialing processes while maintaining standard turn-around times
  • Prepares oversight delegation documentation and processes to conduct pre-delegation activities
  • Gathers and reviews vendor/partner policies and procedures for compliance to regulations and standards
  • Conducts file audits on vendor/partner credentialing records to review for quality and compliance to regulations and standards.
  • Summarize delegation oversight findings and makes recommendations for approval to accept vendor/partner delegated credentialing arrangement.
  • Prepares corrective action plans as needed to ensure vendor/partner is meeting terms of delegation agreement and NCQA/state/federal requirements.
  • Creates and manages provider reporting to ensure ongoing oversight and compliance
  • Ensures the provider information is maintained with accuracy per the delegated arrangements.
  • Responsible for provider credentialing/monitoring data quality and resolution of system/information issues related to credentialing information.
  • Researches and resolves low to moderately complex issues received from external
  • Monitors provider exclusions/sanction information with vendor/partner and takes necessary action to maintain EyeMed Network compliance with each state.
  • Manages the external communications with vendor/partner
  • Leads review of credentialing reports for pattern identification, outlier information and prepares recommendations to correct information based on the analysis performed
  • Trains associates on new process and procedures

Required Skills

  • Bachelors Degree
  • 3+ years of experience in Healthcare Provider Operations including Delegated Credentialing operations and NCQA Standards
  • 3+ years of vendor/partner management
  • Strong analytical and problem solving skills
  • Effective oral and written communication and presentation skills
  • Ability to influence others and gain alignment on issues of significant importance to the company
  • Excellent organizational, problem solving and critical thinking skills
  • Proficient in Microsoft Office Products (Word, Excel, Access)
  • Ability to coach non direct associates and encourage growth.
  • Ability to work well independently, under pressure and multi-tasking
  • Ability to successfully work on multiple projects simultaneously while managing time effectively
  • PREFERRED QUALIFICATIONS :
  • Knowledge of credentialing/provider industry
  • Demonstrates sense of urgency
  • Experience with operating systems such as EDW/Business Objects/AS400/Facets
  • Experience working with IT on system enhancements

Duration

7 + Months

Please Contact me to discuss the hiring process!

Sushil Singh

Sr. Executive Recruiter
Contact: (310) 929-8421 Ext: 107
Email: sushil.singh@staffactory.com

Hi! My name is Sushil Singh. Helping consultants with getting their desired job is what makes me feel alive. I build a unique relationship with each of my consultants and work on their profile as per their needs. I believe that my consultants are my assets and this motivates me to serve them in an even better manner. Hence, I work towards the success of every consultant I work with.