Delegation Oversight Coordinator Credentialing

Credentialing Delegation Oversight Auditor

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.

This 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. The position reviews adherence to regulatory and contractual requirements, develops audit tools based on credentialing operations, state and federal regulations, and conducts the reviews in accordance with accreditation standards and credentialing guidelines. Creates reports regarding audits, analyzes, tracks and trends audit findings, and develops and monitors corrective actions. 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 :

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.

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 - $110,000.00. Exact compensation may vary based on skills, experience, and location.

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HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants. If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1-866-977-7378 to request reasonable accommodations. Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process.

Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas, Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association Copyright 2025 Health Care Service Corporation. All Rights Reserved.