Credentialing Delegation Oversight Coordinator

1 week ago


Broken Arrow, Oklahoma, United States Health Care Service Corporation Full time
Job Summary

This role is responsible for leading and coordinating Credentialing Delegation oversight audits of HCSC's vendors, service providers, medical groups, and/or delegated subcontracted providers to ensure adherence to regulatory and contractual requirements.

The position develops audit tools based on Credentialing/Re-credentialing operations, state and federal regulations, and conducts reviews in accordance with accreditation standards and Credentialing guidelines.

Key responsibilities include creating reports regarding audits, analyzing and tracking trends, developing and monitoring corrective actions, and providing feedback to practitioners on performance.

Required Qualifications:
  • Associate Degree in Business or Medical or 3+ years' experience in a managed care environment.
  • 2 years in a leadership role with direct accountability and responsibility for staff.
  • 4 years' experience in Credentialing operations performing delegated oversight activities.
  • 4 years auditing Credentialing files or Credentialing operational experience.
  • Project Management skills and experience.
  • Knowledge of regulatory/accreditation requirements and standards (Department of Insurance, NCQA, URAC).
  • Verbal and written communication skills.
  • Organizational skills and ability to handle multiple priorities.
  • PC proficiency to include Word, Excel, PowerPoint, Adobe Acrobat, and Outlook.
Preferred Qualifications:
  • 4 years specific DELEGATION experience.
  • Professional working knowledge of Excel and Adobe Acrobat.
  • Experience with PowerBI.
  • Bachelor Degree in Business or Medical-related fields.

This is a hybrid opportunity that will work from the office 3 days a week. Must live in a commutable distance to the listed office.

Sponsorship will not be provided for this role.

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