Delegation Analyst - Health Plan Job

Children's Health - HMO Careers

Job Number: 51435

Location: Dallas, TX

Date Posted: 2-22-2017

Description:

Position Summary

Responsible for coordinating the delegated oversight activities to ensure compliance with state, federal, NCQA, and Children's Medical Center Health Plan (CMCHP) requirements.

Essential Duties and Responsibilities

  • Arrange for mailing of pre-audit letters/audit tools/annual reporting requirements.
  • Responsible for performing pre-delegation and annual credentialing audits and monitoring of delegated activities to ensure compliance with NCQA, State and Federal requirements.
  • Reviews the delegates’ policies and procedures, provider files and evidence of ongoing monitoring to ensure quality.
  • Conducts and completes delegation oversight audits.
  • Maintains expertise in NCQA standards, regulations and measurement techniques.
  • Possesses and maintains in-depth knowledge of current Credentialing requirements and standards.

Qualifications

Education

  • Four-year Bachelor's degree or equivalent experience

Experience

  • Two years credentialing oversight experience, required
  • Extensive knowledge of Microsoft Word/Excel, required
  • Cactus expert user, preferred

Specific knowledge, skills and abilities

  • Maintain effectiveness when experiencing major changes in work responsibilities or environment; adjust effectively to work within new work structures, processes, requirements, or cultures.
  • Use appropriate interpersonal styles to establish effective relationships with customers and internal partners; interact with others in a way that promotes openness and trust and gives them confidence in one's intentions.
  • Ensure that the customer perspective is a driving force behind business decisions and activities; craft and implement service practices that meet customers' and own organization's needs.
  • Develop and use collaborative relationships to facilitate the accomplishment of work goals.
  • Identify and understand issues, problems, and opportunities; compare data from different sources to draw conclusions; use effective approaches for choosing a course of action or developing appropriate solutions; take action that is consistent with available facts, constraints, and probable consequences.
  • Take prompt action to accomplish objectives; take action to achieve goals beyond what is required; be proactive.
  • Deal effectively with others in an antagonistic situation; use appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.
  • Effectively manage one's time and resources to ensure that work is completed efficiently.
  • Accomplish tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.
  • Set high standards of performance for self and others; assume responsibility and accountability for successfully completing assignments or tasks; self impose standards of excellence rather than having standards imposed.
  • Assimilate and apply new job-related information in a timely manner.
  • Clearly convey information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message.

Physical demands

  • Light - Exerting up to 20 lbs. occasionally, 10 lbs. frequently, or negligible amounts constantly and may require walking or standing to a significant degree.

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