Coordinator Credentialing Delegation Oversight

Role Overview

As a member of the Corporate Credentialing team, the Delegation Oversight Coordinator will interface with delegated provider groups, complete required auditing and reporting related to provider delegation, and ensure adherence with NCQA, and /or state, federal, and business requirements.  Serve as a key contact for communications and ensure compliance with performance metrics.

Responsibilities

• Conduct pre-delegation, annual and corrective action oversight audits
• Continuous monitoring of master spreadsheet of all delegates to ensure timely completion of audits
• Complete annual or more frequent if required on-site or desktop audits
• Submit delegation reports and spreadsheets to appropriate committees
• Coordinate monthly delegate reporting according to the reporting schedule
• Review data specifications with delegates annually to ensure compliance
• Review and revise (as needed) delegation agreement annually to include any NCQA, Federal or State changes
• Assist in managing the delegation policies and procedures
• Interface with the health plan's functional departments to address any service related issues
• Work with CACTUS Enhanced Importer
• Support delegates data entry efforts
• Gatekeeper of all delegate agreements
• Report audit outcomes and delegation monitoring results to management
• Develop, implement and monitor Corrective Action plans, when needed

• Use critical thinking and problem solving skills to help ensure successful delegation partnerships and quality provider data

   

Education and Experience

• Bachelor’s Degree or equivalent work experience

• Displays good judgment in apprising management of situations that are incompatible with established policies for which there is little precedence

   

Skills & Abilities

• Excellent verbal and written communication skills, including the ability to present to small groups
• Strong ability to work independently
• Strong ability to create, monitor, and analysis provider data
• Ability to represent the organization in a professional manner
• Ability to prioritize and manage multiple tasks/priorities simultaneously
• The ability to work in a fast paced environment
• Demonstrate attention to detail
• Strong assessment and problem-solving skills
• Proficient in Access, Word, Excel, Power Point, etc. and company applications i.e., CACTUS, Facets

Our Comprehensive Benefits Package

Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events, health insurance coverage for you and your dependents starting Day 1, 401(k) retirement savings plan, tuition reimbursement, and more.

Why Join Us: Your career starts now. We are looking for the next generation of healthcare leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together, we can build healthier communities. If you are driven to make a difference, we want to hear from you.

About AmeriHealth Caritas

Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. Our services include integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at http://www.amerihealthcaritas.com