Delegated Credentialing Coordinator

Company: One Call
Location: Jacksonville
Posted on: March 20, 2023

Job Description:

Delegated Credentialing CoordinatorWe're looking for colleagues who are ready to Think Big, Go Fast, Deliver Awe, and Win Together. These core values embody our diverse and inclusive culture and help us live out our mission of "getting people the care they need when they need it." Over the last 30 years, our company has established itself as the market leader in managed care for the workers' compensation industry. We are committed to making a positive impact in the lives of the injured workers we serve, and we have fun doing it.--Salary Range:--22.45 - 33.70 HourlyThis compensation range takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At One Call, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is 22.45 - 33.70 HourlyBenefits Summary:--In return for your commitment to our company's mission, we offer a vast array of benefits to help support the whole you.--

• Opportunities to work from home--
• Competitive wages with opportunities to earn annual merit increases--
• Paid development hours to use for professional and community development!--
• Generous paid time off, 8 company holidays, and 2 floating holidays per year--
• $1,000 Colleague Referral Program--
• Enterprise Recognition Program rewarding colleagues for their extraordinary work--
• Exclusive discounts on travel, activities, and merchandise via work discount program--
• Colleague Assistance Program that provides free counseling and financial services--
• Tuition Reimbursement Program including certifications--
• Quantum Health: A healthcare navigation platform to help our colleagues make the best, most cost-effective healthcare decisions--
• Medical, dental, and vision insurance--
• Pre-Tax FSA and HSA health savings accounts--
• 401(k) matching--
• Company paid life insurance--
• Company paid short term and long-term disability--
• Referral program
• Healthcare concierge--
• The One Call Foundation which aims to help colleagues during unexpected emergencies, from car accidents to natural disasters.----The Delegated Credentialing Coordinator is responsible for processing applications and support the ongoing participation requirements for all One Call Network Delegated Credentialed Providers in accordance with One Call delegation polices, NCQA, URAC, TJC standards, and other applicable federal, state regulatory and or accrediting agencies. The person in this role will work problems of diverse scope where analysis of data requires evaluations of identifiable factors. Must be passionate about contributing to an organization focused on continuously improving provider experiences.--GENERAL DUTIES & RESPONSIBILITIES:----CREDENTIALING: 45%
  • Coordinates all aspects of delegated credentialing, serving as resource to the One Call Network Delegated Providers
  • Perform detailed and thorough review and analysis in support of pre-delegation audits for newly contracted Providers requesting delegation, to ensure that the Provider meets the necessary requirements to be granted delegation for credentialing in coordination with One Call delegated policies, and Payor Delegation contract as documented in the delegated provider's policies and procedures and as confirmed through individual practitioner credentialing file audits.--
  • Monitors, and performs detailed and thorough review and analysis in support of annual audits for each Delegated Provider to ensure continued compliance and in coordination with One Call delegated policies, and Payor Delegation contracts as documented in the delegated provider's policies and procedures and as confirmed through individual practitioner credentialing file audits.
  • --Compiles electronic files, determines audit results, evaluates reports, and communicates findings to Delegated Credentialing Manager--COMPLIANCE: 45%
    • Responsible for ensuring compliance with credentialing delegation oversight for Providers to whom delegation has been granted--in include confirmation and monitoring of--delegation compliance with contractual terms.
    • Engage in quality control activities within Provider Relations/Provider Governance and Risk Department and delegated entities in support of internal and delegated payor audits.
    • Ensure compliance with payor policies, State, Federal, and NCQA requirements associated with delegated credentialing.
    • Implement and oversee corrective action plans for delegated Providers who fall out of compliance.
    • Facilitates priority appeals and efficient due process that complies with One Call's fair hearing and appeals policy as well as applicable legal and regulatory requirements.
    • Supports the Delegated Credentialing Manager in compliance with the management of third-party relationships, including our credentialing vendor, health plans, and our physician partners, to best support organizational goals.
    • Encourage opportunities for improvement to Delegated Providers by providing interpretation of One Call delegated policies and credentialing standards to encourage quality and compliance for successful audits
    • --Assist with preparation of delegation oversight materials for internal and external auditsADMINISTRATIVE: 10%--
      • --Maintains appropriate status and notes in the credentialing database.
      • --Maintain continuous, consistent data integrity to ensure that accurate and current information is available to all systems and departments.
      • Complete outreach to delegated providers in accordance with the outreach schedule both telephonically and electronically.--
      • Internal communications with Provider Network and other departments within One Call.EDUCATIONAL AND EXPERIENCE REQUIREMENTS:--
        • 1- 2 years college--preferred, or some college with knowledge and skills gained in healthcare setting, particularly in delegated credentialing processes
        • At least 3 years' experience directly related to delegated credentialing activities to include:-- delegation audits, delegation compliance, delegation communications.------
        • --Experience with computer systems required, including web-based applications and Microsoft Office applications which include Outlook, Word, Excel, PowerPoint, and PDF.GENERAL KNOWLEDGE, SKILLS & ABILITIES:--
          • General knowledge of the U S Healthcare system and workers compensation industry.
          • Ability to express thoughts clearly, concisely, with extremely effective and polished verbal and communication skills. Excellent listening skills and reading and writing comprehension to technical and non-technical audiences of various levels within the organization (e.g., executive, management, individual contributors).--
          • Ability to work independently and prioritize work, recognize investigate, validate discrepancies and information obtained, and follow through on issue resolution with minimal management intervention in a high pace environment.--
          • Excellent independent and critical thinking, problem solving, time management, and work prioritization skills.--
          • Requires proficient negotiation skills and tactics, both written and verbal.--
          • Self-starter with experience handling high work volume and multiple projects.--
            • Ability to establish and maintain positive relationships with internal and external customers and be a team player.--
            • Ability to think and work effectively in a high-pressure environment. Comfortable with change and possesses the ability to switch tasks and priorities seamlessly. Ability to adapt behavior in response to new information or changing circumstances.-- Is open to change and new information, ideas, methods, or approaches.---- Work and collaborate effectively and adjusts to original objective or plan to allow for the best possible results.--
            • Demonstrates active listening and gives full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, not interrupting at inappropriate times, understanding the implications of new information for both current and future problem-solving----
            • Must be able to successfully maintain multiple projects simultaneously, manage and meet multiple deadlines, be detail-oriented, and possess strong organizational skills.--
            • Ethical conduct and the ability to respect and preserve confidential information entrusted in the course of professional duties is necessary. Reveals confidential information only to appropriate parties and in accordance with any applicable law. Maintains confidentiality regarding legal matters, privacy issues, information technology, and data integrity.--
              • Patient and Customer Focused: ability to put yourself in our patient's and provider's shoes.-- Commitment to Patient safety and Positive Provider Engagement Experiences.--
              • Quality of Work: freedom from errors and mistakes with the ability to consistently meet objectives; high attention to detail.--
              • Value and model integrity and honesty by acting in a just, fair, and ethical manner and encouraging ethical behavior among others. Inspire trust and confidence among stakeholders through reliability, authenticity, and accountability.--
              • Display a credible presence and positive image when representing One Call.--
              • Performs other related duties as assigned.--
                • Strategic Perspective: understands the position of the organization with a global context. Able to anticipate future trends, consequences, and opportunity-costs, and to map a clear path of acceleration toward strategic opportunities.--
                • Commit to continuous performance and process improvement.--
                • Encourage and facilitate cooperation, trust, and group identity; and builds commitment, team spirit, and strong relationships.
                • --Work collaboratively and relate effectively to others by practicing, valuing, and embracing diversity of individuals, and fostering respect and equity in the workplace.PHYSICAL/EMOTIONAL DEMANDS & WORK ENVIRONMENT:
                  • The Physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
                  • For roles located in office or home settings; this job is primarily sedentary and may involve repetitive motions; the employee is regularly required to sit, use hands and fingers, speak, and hear.
                  • --The employee is occasionally required to stand, walk, and lift objects (up to 10 lbs. weight; up to 4 ft. height).
                    • Specific vision abilities required by this job include ability to see things from a close distance and ability to adjust focus.--
                    • The work environment utilizes florescent lighting; noise level is moderate.--
                    • The emotional demand of the job may cause undue stress from, but not limited to, moderate/heavy workload.--
                    • Ability to work long hours - over eight in a workday, and over 40 in a work week, as necessary. Reasonable accommodations will be individually assessed and possibly made to enable individuals with disabilities to perform the essential functions of the position.
                    • --Please be advised this job description is subject to change at any time.--

Keywords: One Call, Jacksonville , Delegated Credentialing Coordinator, Accounting, Auditing , Jacksonville, Florida