Title: Delegated Credentialing Coordinator

Job ID: 2024-158573

Department: Corp Physician Integration

Site: HMH Physician Services, Inc.

Job Location: US-NJ-Neptune

Position Type: Full Time with Benefits

Standard Hours Per Week: 40

Shift: Day

Shift Hours

Day: Weekend Work

No Weekends Required

On Call Work: No On-Call Required

Holiday Work: No Holidays Required

Job Description:

Overview

Our team members are the heart of what makes us better.

At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community.

Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

The Delegated Credentialing Coordinator is responsible for coordinating and performing all credentialing functions including pre-delegation and annual due diligence audits and monitoring of practitioner and delegated credentialing activities to ensure compliance with National Committee for Quality Assurance (NCQA), contractual agreements, and State and Federal requirements. The Delegated Credentialing Coordinator position will function in a hybrid work environment, carrying out job responsibilities remotely and in part onsite if needed.

Responsibilities

A day in the life of a Delegated Credentialing Coordinator at Hackensack Meridian Health includes:

The primary role of the Delegated Credentialing Coordinator is to complete, both, delegated and traditional credentialing files accurately.
Demonstrate a solid understanding of credentialing and NCQA guidelines around Credentialing and Provider Network.
Verifying the accuracy of all submitted credentialing information, and for creating, or auditing accurate Primary Source Verification (PSV) files for delegated credentialing and maintain NCQA Credentialing/Recredentialing Accreditation.
Performing all activities related to physician credentialing, re-credentialing, and delegation including but not limited to identifying discrepancies in information and conducting follow up, presenting applications to the Credentialing Committee, assisting customers with credentialing inquiries, responding to health plan provider inquiries, capturing primary source documentation, ensuring data is backed up, ensuring compliance with all applicable laws, regulations, procedures, and policies.
Ensuring compliance to delegation agreements.
Assist in maintaining credentialing policies and procedures.
Participate in delegation audits, supplying information as needed.
Perform tasks related to external audits from contracted health plans/employer groups as well as pre-delegation review with potential health plans as required.
Monitor providers due for recredentialing and confirm they are recredentialed timely.
Coordinate with delegated partners to ensure adherence to all regulations, contractual agreements, NCQA, HIPAA, and URAC guidelines.
Supports the use of process and performance improvement data to support best practice processes and implement change as needed.
Collaborates with CVO leaders in support of an ongoing performance improvement and reporting process that is accurate, timely and action driven.
Provides and supports ongoing communication with CVO leaders especially in regards to risk/issues identified during the credentialing/recredentialing process for delegated credentialing.
Contributes and supports technology integration and migration with other system information systems as needed.
Provides support to Manager, Credentialing and Coordinators to help ensure continuous compliance with state and federal laws, organization policies, regulatory agencies and accrediting body standards [CMS, JC, NCQA, HFAP, DNV, AAAHC, URAC, as applicable.].
Participates in department teams processes to confirm compliance on an ongoing basis.
Assures confidentiality is maintained at all times in all aspects of delegated credentialing process.
Consults with Medical Services Professionals (MSPs in MSOs, CVOs, MCOs, etc.).
Other duties and/or projects as assigned.
Adheres to HMH Organizational competencies and standards of behavior.

Qualifications

Education, Knowledge, Skills and Abilities Required:

High School diploma, general equivalency diploma (GED), and/or GED equivalent programs.
2+ years in industry healthcare setting.
1+ years in Enrollment/Delegated Credentialing.
Takes accountability, uses initiative, possesses critical thinking skills, uses good judgment, seeks guidance as needed.
Strong interpersonal skills, teamwork and communicates effectively.
Ability to effectively interact with populations of patients/customers with an understanding of their needs for self-respect and dignity.
Overall working knowledge of software programs with a drive to incorporate technology in all operational functions.
Strong organizational skills.
Detail driven.
Excellent communication skills.
Gets results.
Drives service excellence.

Education, Knowledge, Skills and Abilities Preferred:

Associates degree in Health Care Administration or related field.

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