Managed Care Delegation Specialist

Job description

It's more than a career, it's a calling.

nMO-REMOTE

nWorker Type:

nRegular

nJob Highlights:

nJoin a team that plays a key role in ensuring provider data accuracy, regulatory compliance, and strong partnerships across the healthcare ecosystem.

nAs a Managed Care Delegation Specialis t, you'll work closely with providers, health plans, and internal teams to support delegated functions, maintain data integrity, prepare for audits, and drive operational excellence.

nThis is an ideal opportunity for someone who enjoys problem-solving, working with complex data, building provider relationships, and supporting operational excellence across the healthcare continuum.

nCandidates should reside in MO, OK, WI or Southern IL. Hybrid role with initial onsite training and occasional in-person meetings required.

nSchedule - M-F with start and stop times between 6am and 6pm. Candidate schedule during this timeframe must be consistent.

nThe selected candidate will support all Regions.

nJob Summary:

nResponsible for provider enrollment with commercial payors, managed care contracts, and delegation audit activities for the system hospitals or organization. Works independently with complex data and situations.

nJob Responsibilities and Requirements:

nPRIMARY RESPONSIBILITIES

nnnEnsures providers are credentialed and enrolled in insurance plans.

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nnActs as a liaison between medical staff offices, credentialing verification offices, and delegation payors.

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nnRemains knowledgeable of medical staff bylaws, rules and regulations, and policies for the system hospitals or organization. Stays up to date with National Committee for Quality Assurance (NCQA) standards and reports back to stakeholders with new information pertinent to credentialing.

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nnManages delegated credentialing processes and assists in contracting with managed care plans. Reviews and interprets new and existing contracts to ensure they meet Managed Care Organization (MCO) specifications. Negotiates recommended changes to contracts to ensure compliance.

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nnEnsures monthly and quarterly notifications for provider updates are distributed. Provided notifications of on-going rosters, new providers, resignations and/or change of status requests, location changes, and/or changes in provider privileges.

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nnUtilizes a variety of databases and query tools to gather data. Ensures all requirements are well-defined from the MCO to meet reporting and analysis specifications.

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nnWorks closely with team members to establish reporting and dashboards within applications that will support operations.

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nnResolves reimbursement discrepancies with payors for credentialing issues.

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nnPerforms other duties as assigned.

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n nEDUCATION

nnHigh School diploma/GED or 10 years of work experience

n nEXPERIENCE

nnnAt least 3 years of experience working with providers, provider offices, or provider networks in a healthcare setting.

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nnExperience supporting credentialing, managed care operations, provider relations, provider enrollment, medical staff services, or healthcare compliance activities.

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nnFamiliarity with delegated functions such as credentialing, utilization management, prior authorization, claims, or provider data management.

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nnExperience using credentialing or provider management systems.

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nnStrong Microsoft Excel skills, including experience tracking metrics, validating data, generating reports, and identifying discrepancies.

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nnExperience maintaining, auditing, or analyzing large volumes of provider, credentialing, or operational data.

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nnKnowledge of healthcare regulatory, compliance, audit, payer, or accreditation requirements.

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nnDemonstrated attention to detail with the ability to ensure accuracy, completeness, and compliance of records and documentation.

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nnExperience preparing documentation for audits, monitoring corrective actions, or supporting compliance reviews.

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nnStrong communication and collaboration skills with the ability to work effectively across departments and with external stakeholders.

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n nREQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS

nnNone

n nDepartment:

n Provider Enrollment

nWork Shift:

nDay Shift (United States of America)

nScheduled Weekly Hours:

n40

nSSM Health is an Equal Opportunity Employer. SSM Health provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, gender, pregnancy, sexual orientation, gender identity, national origin, age, disability, protected veteran status, genetic information, or any other characteristic protected by applicable federal, state, or local law. Click here to learn more. (

Who can apply

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