Delegation Oversight Coordinator - Work From Home

HCSC•Richardson, TX

19h•Remote

About The Position

This position is responsible for creating, managing and reporting processes designed to monitor and evaluate activities and functions delegated to contracted, delegated entities and vendors for assigned products and business lines according to all corporate and regulatory/accreditation requirements and standards. This person will also monitor timeliness of all claims, accuracy of payments and denial ratios, as well as quarterly and annual financial accuracy audits. Ability to travel (as business need arises; within assigned territory; less than 10%).

Requirements

Bachelor's degree in Business or Medical OR 4 or more years' experience in a managed care environment.
4 years in a leadership role that includes direct accountability and responsibility and direction of staff.
4 years’ experience in directly performing delegated oversight activities.
Project Management skills and experience.
Knowledge of regulatory/accreditation requirements and standards (TDI, NCQA, URAC).
Verbal and written communication skills.
Organizational skills and the ability to handle multiple priorities.
PC proficiency to include Word, Excel, PowerPoint and Lotus Notes.
Ability to travel.

Nice To Haves

Knowledge of Power Point and Visio.
Customer service experience (call scripts, call metrics, identify callers for PHI security, resolving inquiries, protocol adherence, etc).
Tele-sales experience (State Department of Insurance regulations adherence).
Polished and professional email and phone etiquette; customer service minded
Ability to work under strict regulations and timelines
Ability to navigate multiple projects with varying deadlines

Responsibilities

Creating, managing and reporting processes designed to monitor and evaluate activities and functions delegated to contracted, delegated entities and vendors for assigned products and business lines according to all corporate and regulatory/accreditation requirements and standards.
Monitoring timeliness of all claims, accuracy of payments and denial ratios.
Conducting quarterly and annual financial accuracy audits.