Delegation Oversight Coordinator
PacificSource

Job Info

---

Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Position Overview: Responsible for auditing PacificSource and IPN credentialing delegates on an annual basis. Oversite of delegation policies and procedures as well as data entry of delegate data obtained from current rosters submitted to the credentialing department. Responsible for credentialing and recredentialing practitioners and facilities in accordance with PacificSource policies and procedures, ensuring compliance with National Committee for Quality Assurance (NCQA) standards and state and federal regulatory bodies. Responsible for the ongoing maintenance of files, preparation of files for audits, as well as electronic database input and management. Communicate directly with practitioners and facilities on credentialing issues and medical practice information.

Essential Responsibilities:

• Audit credentialing compliance of entities delegated to perform credentialing activities for PacificSource. Conduct independent audits of delegated entities' practitioner files, and ensure their policies and procedures are in compliance with PacificSource credentialing standards, the NCQA standards, and state and federal regulatory bodies.
• Determine audit results and communicate findings to Delegates in a non-punitive manner. Encourage opportunities for improvement.
• Perform annual on-site delegated credentialing audits on entities that PacificSource delegates credentialing activities. Complete delegation report, review with the Credentialing Committee and Chief Medical Officer, and draft correspondence to notify delegates of audit results.
• Perform practitioner office site audits regarding physical access and facility site visits in lieu of accreditation.
• Maintain collaborative relationships and act as a liaison for PacificSource with IPAs and other health plans. Provide interpretation of NCQA, CMS and Medicaid credentialing standards to Delegates to encourage quality and compliance for successful audits.
• Perform internal audits of practitioner and facility credentialing and recredentialing files to ensure accurate and high quality performance standards and PRISM measures are met. Report any quality deficiencies to the Credentialing Manager.
• Entry of delegation updates into Cactus as well as updating the semi-annual delegation logs to present to credentialing committee.
• Maintain all delegation auditing tools and policies to meet current accrediting and regulatory body standards.

Supporting Responsibilities:

• Maintain familiarity with PacificSource credentialing policies and procedures, National Practitioner Data Bank (NPDB) reporting requirements, State Medical Board policies, NCQA credentialing standards, and state and federal regulatory credentialing requirements. Attend workshops and seminars to increase and maintain knowledge as necessary.
• Maintain strict confidentiality of all practitioner/facility records, data, and occurrences.
• Meet department and company performance and attendance expectations.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Assist with preparation of delegation oversight materials for internal and external audits.
• Perform other duties as assigned.

Work Experience: Minimum three years credentialing and delegated credentialing experience in the credentialing field and/or equivalent experience.

Education, Certificates, Licenses: High School Diploma or equivalent required. NAMSS Certified Provider Credentialing Specialist Certification (CPCS) preferred. Obtain and maintain certification through the National Association of Medical Staff Services within 2 years of hire. Either Certified Professional Medical Services Management (CPMCM) or Certified Provider Credentialing Specialist (CPCS) certification.

Knowledge: Effective written and verbal communication skills. Must be highly organized and possess strong interpersonal skills. Knowledge of NCQA credentialing and delegation standards as well as state and regulatory credentialing requirements. Knowledge of policy and procedure development. Knowledge of requirements and functions of the Credentialing Committee and how it contributes to the credentialing functions. Maintain regular contact with PacificSource Provider Network Management Department to update current practitioner information. Computer skills, including word processing, spreadsheet, database applications and medical terminology.

Competencies

• Adaptability
• Building Customer Loyalty
• Building Strategic Work Relationships
• Building Trust
• Continuous Improvement
• Contributing to Team Success
• Planning and Organizing
• Work Standards

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel to practitioner office sites and external partners of PacificSource to conduct audits. Travel is required approximately 60% of the time.

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

This job has expired.