April 8, 2019
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.
- 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
- 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
7 + Months
Please Contact me to discuss the hiring process!
Sr. Executive Recruiter
Contact: (310) 929-8421 Ext: 107
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.