Delegation Credentialing Coordinator
About the job
HealthPartners is hiring a Delegation Credentialing Coordinator. This position exists to implement, coordinate and evaluate all aspects of delegated credentialing activities for HealthPartners, and to support the management of credentialing, recredentialing and privileging activities within HealthPartners, as well as hospitals and physician group practices contracting with HealthPartners
MINIMUM QUALIFICATIONS:
Education, Experience or Equivalent Combination:
Bachelor’s degree and two years managed care or healthcare setting credentialing or related experience, or High School Diploma/GED and five years managed care or healthcare setting credentialing or related experience.
Knowledge of and experience dealing with practitioner credentialing and NCQA standards.
Licensure/ Registration/ Certification:
None
Knowledge, Skills, and Abilities:
Detailed oriented and strong organizational skills
Demonstrated ability to work independently and represent HealthPartners as the authority on delegated credentialing issues in addition to other issues that may arise.
Analytical skills required to analyze and interpret data into meaningful reports.
Ability to work with multiple departments and organizations to deliver results.
Experience and skills with Microsoft windows, Word, Excel, PowerPoint and Power BI
Ability to plan, organize and prioritize work effectively, including the flexibility to accommodate frequent changes.
Excellent oral and written communications skills.
Strong analytical and problem-solving skills.
PREFERRED QUALIFICATIONS:
Licensure/ Registration/ Certification:
CPCS certification
Knowledge, Skills, and Abilities:
At least one year leadership experience.
Experience dealing with implementing NCQA credentialing standards.
Understanding Medical terminology.
Essential Duties:
% Of Time (minimum 5% increments)
1.
Plans, schedules, and independently conducts annual audits of delegated credentialing entities; runs and reviews required oversight reports to monitor delegated activities and ensure compliance with the HealthPartners Credentialing Plan, NCQA, CMS, and Minnesota DHS requirements.45%
2.
Assesses audit results and recommends to the Quality Review Committee regarding continuation, corrective measures, or termination of delegation. Communicates audit findings to the delegate and monitors progress, ensuring follow-up and completion of corrective actions.20%
3.
Participates in and responds to audit and oversight requests from external organizations and regulators that delegate credentialing functions to HealthPartners.15%
4.
Collaborates with other health plans via the Minnesota Council of Health Plans Delegation Collaboration to promote uniform and effective delegation practices. Engages actively in Minnesota collaborative meetings and discussions.
5%
5.
Maintains current knowledge of credentialing standards and regulatory requirements (e.g., NCQA, CMS, state/federal regulations) and collaborates with leadership to update processes to ensure compliance.4%
6.Educates delegated entities on updates to the HealthPartners Credentialing Plan, accreditation standards, and regulatory requirements.4%7.Partners with the Credentialing Data Analyst to resolve delegated data questions, discrepancies, and reporting issues.3%8.Maintains internal delegation-related policies, procedures, and tools; trains new DBMAs and audits delegated data entry for quality and compliance.3%9.Performs additional projects and responsibilities as assigned by the Manager and/or Director.
1%*Job description rankings/percentages are intended to reflect normal averages over an extended period of time and are subject to daily variances. Quality and efficiency standards should at no time be compromised to meet the average expectations expressed above. Job descriptions are subject to change to accommodate organization or department needs.
At HealthPartners we believe in the power of good – good deeds and good people working together. As part of our team, you’ll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.
We’re a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.
At HealthPartners, everyone is welcome, included and valued. We’re working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.
Benefits Designed to Support Your Total Health
As a HealthPartners colleague, we’re committed to nurturing your diverse talents, valuing your dedication, and supporting your work-life balance. We offer a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. Our goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.
Join us in our mission to improve the health and well-being of our patients, members, and communities.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identify, status as a veteran and basis of disability or any other federal, state or local protected class.
