Delegation Oversight Coordinator - JHP

Jefferson Health Plans • Jefferson Township, PA

1d

About The Position

This position is responsible to interface with delegated provider groups, overseeing the credentialing and re-credentialing activities and complete required auditing and reporting related to provider/subcontractor delegation, and ensure adherence with the NCQA, State and Lines of business requirements. Conduct provider delegation audits on an ongoing basis.

Requirements

• High school diploma required.
• Minimum 1 year managed care or healthcare experience preferred.
• Required knowledge of Microsoft Office (Excel and Outlook).
• Excellent attention to detail and organizational skills, knowledge of NCQA, DHS, CMS, and DOH preferred.
• Ability to work independently and as part of a team preferred.

Nice To Haves

• Associate degree preferred.
• CPCS Certification preferred.
• Demonstrate maturity and professionalism, strong communication, problem-solving, and team building skills preferred.

Responsibilities

• Enters and supervises the data that is received on all incoming delegated profiles.
• Communicate with internal departments regarding the delegation process as necessary.
• Review delegated profiles for completion and request missing information.
• Review various sources for sanctions.
• Ensure timeliness and accuracy of the credentialing and recredentialing processes.
• Maintain practitioner files for designated area.
• Assure quality network of practitioners through consistent application of the Health Partners’ Credentialing and Recredentialing Policy requirements.
• Perform all data entry into Credentialing Database for practitioners credentialed, re-credentialed and for any PDC changes received.
• Schedule all delegated oversight audits timely and send confirmation of the audit dates.
• Accurately perform all delegated oversight audits. This includes all local and non-local audits.
• Accurately complete the delegated oversight audit scores after each audit and submit them to the Credentialing Committee Meetings.
• Ensure each delegated entity receives their audit scores timely after each Credentialing Committee Meeting.
• Ensure the timely receipt of all quarterly reports for presentation to the Credentialing Committee for review and approval.
• Perform other duties as assigned.

Benefits

• Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts.
• Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.
• All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED