Delegated Oversight Coordinator

HEALTH PARTNERS, a growing, progressive Managed Care Organization serving the Medicaid and Medicare population in Philadelphia and surrounding counties seeks a Delegated Oversight Coordinator to join its Provider Affairs Team.  We offer excellent benefits, competitive salaries and a great 401(k) Plan.

 

GENERAL DESCRIPTION:  Responsible for overseeing the delegated credentialing and recredentialing activities.

 

KEY REQUIREMENTS:  High school diploma required, some college preferred.  Minimum 1 year  managed care or health care experience preferred.  Must have a valid driver?s license.

Demonstrate maturity and professionalism, strong communication, problem-solving, and team building skills, current knowledge of Microsoft Office, attention to detail, excellent organizational skills, knowledge of NCQA, DPW, CMS, and DOH preferred, ability to work independently and as part of a team, ability to travel to non-local audits required.

 

PRIMARY 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 MHS for practitioners credentialed and for any Provider Information Worksheet 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.  Audit all PIW?s for accurate completion and data entry into CredPro.  Monitor accuracy rate of PIW?s submitted for the Credentialing/Database Manager.  Perform other duties as assigned.