Delegation Credentialing Coordinator

HealthPartners; BLOOMINGTON (MN); On-site; USD 70,000 - 90,000; Full time

Job summary

HealthPartners is seeking a Delegation Credentialing Coordinator to implement and coordinate delegated credentialing activities across HealthPartners and partner hospitals/physician groups.

The role emphasizes auditing, regulatory compliance, and collaboration with multiple departments to ensure data accuracy and adherence to NCQA/CMS requirements.

Qualifications

• Bachelor's degree or equivalent with credentialing experience; NCQA standards knowledge preferred.
• Experience in managed care or healthcare credentialing.
• Strong oral and written communication; can work with multiple departments.

Responsibilities

• Plan and conduct delegated credentialing audits and generate oversight reports.
• Assess audit results and advise on continuation or termination of delegation; communicate findings.
• Respond to audit requests from external regulators; support regulatory compliance.
• Collaborate with Minnesota health plans to promote uniform credentialing practices.
• Maintain updated knowledge of credentialing standards and regulations; update processes as needed.
• Educate delegated entities on credentialing plan updates and regulatory requirements.
• Resolve data questions with Credentialing Data Analyst; address discrepancies and reporting issues.
• Maintain internal policies and tools; train new staff and audit data entry for quality.

Skills

Detail oriented

Organizational skills

Independent work

Analytical skills

Data interpretation

Education

Bachelor's degree or equivalent

High School Diploma/GED with 5 years experience

Tools

Microsoft Word

Excel

PowerPoint

Power BI

Job description

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:

• 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. Participants 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.