At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
Job SummaryThis position is responsible for leading, coordinating and participating in Credentialing delegation oversight audits of HCSC’s vendors, service providers, medical groups and/or delegated subcontracted providers reviewing adherence to regulatory and contractual requirements. The position also develops audit tools based on Credentialing/Re-credentialing operations, state and federal regulations, conducts the reviews in accordance with accreditation standards and Credentialing guidelines. Creates reports regarding audits, and analyzes tracks and trends audit findings. Develops and monitors corrective actions and provides feedback to practitioners on performance.Required Job Qualifications:
- Associate Degree in Business or Medical OR 3 or more years’ experience in a managed care environment.
- 2 years in a leadership role that includes direct accountability and responsibility and direction of staff.
- 4 years’ experience in directly involved in Credentialing operations performing delegated oversight activities.
- 4 years auditing Credentialing file or Credentialing operational experience
- Project Management skills and experience.
- Knowledge of regulatory/accreditation requirements and standards (Department of Insurance, NCQA, URAC).
- Verbal and written communication skills.
- Organizational skills and the ability to handle multiple priorities.
- PC proficiency to include Word, Excel, PowerPoint, Adobe Acrobat, and Outlook.
- Ability to travel (up to 30-40%) Including overnight stays
Preferred Job Qualifications:
- Bachelor Degree in Business or Medical.
- Knowledge of Power Point, Visio and Access.
- College level courses or certification in project management.
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
Pay Transparency Statement:
At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.
The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.
HCSC Employment Statement:We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
Base Pay Range$49,800.00 - $110,000.00Similar Jobs
What We Do
Imagine Something New, Something Different. Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), is the largest customer-owned health insurer in the nation and the fourth largest overall. Operating through our Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas (as well as a variety of affiliates and subsidiaries,) we are expanding access to high-quality, cost-effective health care. We are equipping members with information and tools so they can make the best health care decisions for themselves and their families. HCSC is continuously recognized as an employer committed to community, diversity and inclusion, training and development. HCSC is committed to pioneering the health care space in ways as effective as they are creative. If you are passionate about the impact you want to have through your work, with a desire to apply innovative thinking to new and emerging challenges, we encourage you to learn more about HCSC. Learn about what we stand for, how we work and the difference we’re making in the lives of our 15 million members. Join HCSC and discover what new ways of thinking can mean for you, your community, our customers and our organization. Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.
