Delegated Credentialing Coordinator

Hackensack Meridian Health; Neptune City (NJ); Remote; Full time

Job summary

Hackensack Meridian Health is seeking a Delegated Credentialing Coordinator to oversee credentialing functions including compliance audits and practice monitoring. This full-time, remote position requires at least two years of healthcare industry experience. The ideal candidate will be detail-oriented, with strong interpersonal and organizational skills, committed to supporting healthcare excellence.

Benefits

Health benefits

Dental benefits

Vision benefits

Paid leave

Tuition reimbursement

Retirement benefits

Qualifications

• 2+ years in industry healthcare setting.
• 1+ years in Enrollment/Delegated Credentialing.
• Strong communication and organizational skills.

Responsibilities

• Responsible for all credentialing functions and ensuring compliance with NCQA and contractual agreements.
• Monitoring provider's due for recredentialing and confirming timely recredentialing.
• Participating in audits and maintaining credentialing policies.

Skills

Attention to Detail

Interpersonal Skills

Critical Thinking

Organizational Skills

Communication Skills

Education

High School diploma or GED

Associates degree in Health Care Administration or related field

Job description

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Description

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

Description

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.

This is a full time, remote position.

Responsibilties

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.
  
  

Licenses And Certifications Preferred

• Certified Professional in Medical Services Management or Certified Provider Credentials Specialist with ongoing maintenance of certification encouraged.
  
  

If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!

HMH is committed to pay equity and transparency for our team members. The posted rate of pay in this job posting is a reasonable good faith estimate of the minimum base pay for this role at the time of posting in accordance with the New Jersey Pay Transparency Act and does not reflect the full value of our market-competitive total rewards package.

Job Duties

The starting rate of pay is provided for informational purposes only and is not a guarantee of a specific offer. Posted hourly rates may be stated as an annual salary in the offer and posted annual salaries may be stated as an hourly rate in the offer, depending on the level and nature of the job duties and credentials of the candidate. The base compensation determined at the time of the offer may be different than the posted rate of pay based on a number of non-discriminatory factors, including but not limited to:

• Labor Market Data: Compensation is benchmarked against market data to ensure competitiveness.
• Experience: Years of relevant work experience.
• Education and Certifications: Level of education attained, including specialized certifications, credentials, completed apprenticeship programs or advanced training.
• Skills: Demonstrated proficiency in relevant skills and competencies.
• Geographic Location: Cost of living and market rates for the specific location.
• Internal Equity: Compensation is determined in a manner consistent with compensation ranges for similar roles within the organization.
• Budget and Grant Funding: Departmental budgets and any grant funding associated with the job position may impact the pay that can be offered.
  
  

Some jobs may also be eligible for performance-based incentives, bonuses, or commissions not reflected in the starting rate. Certain positions may also be eligible for shift differentials for work performed on evening, night, or weekend shifts.

In addition to our compensation for full-time and part-time (20+ hours/week) job positions, HMH offers a comprehensive benefits package, including health, dental, vision, paid leave, tuition reimbursement, and retirement benefits. Starting at $30.45 Hourly

Seniority level

• Seniority level

  Executive

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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