Job Description

Awarded the Best Place to Work 2021, Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

Performs credentialing delegation oversight for commercial and government programs to ensure that BCBSAZ complies with state and federal laws, accreditation standards and in compliance with contract terms.

REQUIRED QUALIFICATIONS

Required Work Experience
  • 6 months of experience with vendor or contract organization oversight (Level 1)
  • 1 year of experience with credentialing delegation oversight (Level 2)
  • 3 years of experience with credentialing delegation oversight (Level 3)

Required Education

  • High School Diploma or equivalent.  (All Levels)

Required Licenses

  • N/A
Required Certifications
  • Within 3 years of hire employee must hold a certification from the National Association of Medical Staff Services (NAMSS) in either Certified Professional in Medical Services Management (CPMSM) or Certified Professional Credentialing Specialist (CPCS)

PREFERRED QUALIFICATIONS

Preferred Work Experience
  • 1 year of experience with delegation oversight or vendor oversight in a healthcare industry  (Level 1)
  • 5 years of experience with delegation oversight or vendor oversight in a healthcare industry (Level 2-3)

Preferred Education

  • Bachelor’s degree in business or related field of study (All Levels)

Preferred Licenses

  • N/A
Preferred Certifications
  • CPHQ Certified Professional Healthcare Quality

ESSENTIAL job functions AND RESPONSIBILITIES


Level 1

  • Performs delegation audits with support from management in accordance with accreditation standards.  Audits may include both onsite and virtual
  • Document and summarize findings from delegation audits including documentation of issues found.
  • Supports Compliance with audits related to government lines of business. 
  • Receives and tracks all documentation received from delegated vendors.
  • Presents delegation oversight findings to management, internal and external audiences including audit entities.
  • Develops and monitors corrective action plans (CAPs) for delegated entities.
  • Participates in audits performed by outside entities ensuring compliance with delegation oversight procedures, e.g. CMS.
  • Participates on corporate teams and committees as necessary. 

Level 2

  • Independently performs delegation audits in accordance with accreditation, privacy and regulatory standards.   Develops skills to identify possible risks to delegation including entities which do not meet expectations for delegation.
  • Clearly communicates findings to delegated entities in a professional and courteous manner, providing constructive feedback and next steps.
  • Escalates to management issues identified as part of delegation audits and oversight.  Notifies Compliance of any issues that need to be escalated as part of delegation oversight.
  • Manages projects with multi-disciplinary teams.
  • Works collaboratively with other business owners for delegation oversight.
  • Acquires and maintains an in-depth knowledge of delegation standards specific to credentialing including relevant accreditation and compliance standards.
  • Researches best practices and changes to accreditation and delegation oversight procedures, recommending modifications to procedures for delegation oversight.

Level 3

  • Performs in-depth investigations for possible contract violations related to delegation oversight tasks and functions. 
  • Analyzes changes to accreditation standards and evaluates existing procedures for changes.

ALL Levels

  • Each progressive level includes the ability to perform the essential functions of any lower levels.
  • The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
  • Limited travel may be required to delegated entities to ensure compliance with standards.
  • Performs all other duties as assigned.

REQUIRED COMPETENCIES

Required Job Skills (All Levels)

  • Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
  • Intermediate PC proficiency
  • Intermediate proficiency in spreadsheet, database, presentation and word processing software

Required Professional Competencies (All Levels)

  • Analytical skills to support independent and effective decisions
  • Prioritize tasks and work with multiple priorities, sometimes under limited time constraints.
  • Perserverance in the face of resistance or setbacks.
  • Effective interpersonal skills and ability to maintain positive working relationship with others.     
  • Verbal and written communication skills and the ability to interact professionally with a diverse group, executives, managers, and subject matter experts.
  • Maintain confidentiality and privacy, maintaining peer review protection. 
  • Analytical knowledge necessary to evaluate potential delegates and make decisions based on data (Levels 2-3)  

Required Leadership Experience and Competencies (All Levels)

  • Take appropriate risks using available data          
  • Build synergy with a diverse team in an ever-changing environment.
     

PREFERRED COMPETENCIES

Preferred Job Skills (All Levels)

  • Advanced skill in use of office equipment, including copiers, fax machines, scanner and telephones
  • Advanced PC proficiency
  • Advanced proficiency in spreadsheet, database, presentation and word processing software

Preferred Professional Competencies (All Levels)

  • Expert knowledge of delegation standards including URAC or NCQA (Levels 2-3)
  • Ability to work with ambiguous and conflicting information while keeping focused on the end goal.
  • Excellent communication skills both in writing and verbally

Preferred Leadership Experience and Competencies

  • N/A

Our Commitment

BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona.  For more information on our company, see azblue.com.  If interested in this position, please apply.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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