Job Details

Position Purpose: Interface with delegated groups, complete required auditing and reporting related to delegation, and ensure adherence with NCQA requirements for assigned function.

Education/Experience: Bachelor's degree in Business, Healthcare related field, or equivalent experience. 2+ years of delegation or related provider data experience.

License/Certification: Valid driver's license and car insurance may be required. • Conduct delegation audits for assigned function
• Communicate reporting requirements and related activities to delegated entities
• Ensure compliance with delegation monitoring and oversight requirements for assigned function
• Assist in managing policies and procedures relating to delegation maintenance
• Assist with Credentialing Committee activities
• Report audit outcomes and delegation monitoring results to management
• Ensure successful delegation partnerships and department quality
• Assist with other related activities as needed
• Depending on assigned health plan, ability to travel

EEO:

"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."

"Position Purpose:
Interface with delegated groups, complete required auditing and reporting related to delegation, and ensure adherence with NCQA requirements for assigned function.

Education/Experience:
Bachelor's degree in Business, Healthcare related field, or equivalent experience. 2+ years of delegation or related provider data experience.

License/Certification: Valid driver's license and car insurance may be required." "Conduct delegation audits for assigned function

Communicate reporting requirements and related activities to delegated entities

Ensure compliance with delegation monitoring and oversight requirements for assigned function

ssist in managing policies and procedures relating to delegation maintenance

ssist with Credentialing Committee activities

Report audit outcomes and delegation monitoring results to management

Ensure successful delegation partnerships and department quality

ssist with other related activities as needed

Depending on assigned health plan, ability to travel
Performs other duties as assigned

Complies with all policies and standards" Story Behind the Need - Business Group & Key Projects

• Health plan or business unit
• Team culture
• Surrounding team & key projects
• Purpose of this team
• Reason for the request
• Motivators for this need
• ny additional upcoming hiring needs?

The Delegation Team process requests from our Delegated Entities. We currently have 39 delegated groups with 13 in process of becoming delegated. Delegated provider Requests are received via email through a shared mailbox. The Candidate will be responsible for the following:

• Serve as the point of contact for delegated entities related to delegation matters.
• Manage monthly delegated rosters and reconciliation.
• Maintain accurate and up-to-date provider information in databases.
• Provide confirmation to delegated entities regarding their practitioners and facilities.
• Collect annual required documents such as Disclosure of Ownership forms and W9
• Repapering all delegated entities with the new Delegated Contract Agreement
• Compile and assemble pre-delegation packet for prospect delegated entity and ensure they adherence with delegation requirements.
• Background screenings as needed
• Quarterly Administrative Subcontractors and Affiliates Report
• Communicate with our delegates
• ttend meetings as needed
• Partnering with our internal customers as needed
• Work special projects as needed

The turnaround time for this team is 45 days. This team is in the pipeline to start getting audited this year and the required consecutive passing score of 95% to start which will increase to 99% once the team is acclimated to the audit process. The Delegation Team is currently made up of 4 Delegation Specialist and one Sr. Delegation Specialist. Typical Day in the Role

• Daily schedule & OT expectations
• Typical task breakdown and rhythm
• Interaction level with team
• Work environment description

During the training/learning process the opportunity for OT will not be available. Once the employee can meet our required metrics of completing 300 monthly submissions during their 8hr shift, and is able to work independently, the OT opportunity will be extended. Daily schedule is 8:00am - 4:30pm. which can be flexible during the day. The employees are assigned groups which they will be responsible for processing their requests and serve as their point of contact for delegated matters. Requests are received through a shared delegation mailbox. Time management is crucial, using practical judgment, , attention to detail, organizational skills, the ability to prioritize & pivot, communicational skills(written & verbal), problem solving and work under pressure. Compelling Story & Candidate Value Proposition

• What makes this role interesting?
• Points about team culture
• Competitive market comparison
• Unique selling points
• Value added or experience gained

What makes this role interesting is that once you develop a work process, there is always something that needs to be done. Our key initiative is to become and remain current with the delegated requests receive in the mailbox. Completing requests in a timely manner to prevent member impact, AHCA complaints or provider abrasion. We have a 45-day turnaround time we must achieve and maintain. Candidate Requirements Education/Certification Required: Bachelor's degree Preferred: Licensure Required: Preferred:

• Years of experience required
• Disqualifiers
• Best vs. average
• Performance indicators

Must haves: Excel, Reporting knowledge, 5 yr minimum experience in corporate world or professional field 2+ years of delegation or related provider data experience

Nice to haves: NAMSS Credentialing Certification, knowledge of NCQA Standards

Disqualifiers: not meeting must haves

Performance indicators: The turnaround time for this team is 45 days. This team is in the pipeline to start getting audited this year and the required consecutive passing score of 95% to start which will increase to 99% once the team is acclimated to the audit process. The Delegation Team is currently made up of 4 Delegation Specialist and one Sr. Delegation Specialist.

• Top 3 must-have hard skills
• Level of experience with each
• Stack-ranked by importance
• Candidate Review & Selection

1 Excel formulas, Reporting 2 Communication Skills, written, verbal 3 Time Management Candidate Review & Selection

• Shortlisting process
• Second touchpoint for feedback
• Interview Information
• Onboard Process and Expectations

Projected HM Candidate Review Date: Max 2 business days after receiving resumes Number and Type of Interviews: One interview per candidate - TEAMS Extra Interview Prep for Candidate: n/ Required Testing or Assessment (by Vendor): none Manager Communication Preferences & Next Steps

• Background Check Requirements (List DFPS or other specialty checks here)

n/

• Do you have any upcoming PTO?

No