Credentialing & Compliance Analyst

Highmark Health; Elm (PA); On-site; USD 32,000 - 49,000; Full time

Job summary

Highmark Inc. seeks a credentialing professional to coordinate and maintain delegated credentialing programs in compliance with NCQA, DPW, and DOH standards. You will oversee pre-delegation assessments, audits, and ongoing monitoring of recommendations and action plans.

Responsibilities include developing workflows, reporting, and communications with other departments to resolve barriers and ensure accurate data submission. Travel may be required.

Qualifications

• 3 years of experience in health care/managed care.
• 3 years of experience in credentialing/re-credentialing of practitioners/providers.
• 3 years of experience with NCQA and other regulatory standards.

Responsibilities

• Coordinate and maintain delegated credentialing program per standards.
• Oversee pre-delegation assessments, annual audits, and ongoing monitoring.
• Develop and monitor corrective action plans to ensure compliance.
• Prepare evaluation reports on delegate performance and issues.

Skills

Healthcare experience

Credentialing experience

NCQA standards

Education

High school diploma or GED

Bachelor’s degree (preferred)

Job description

Highmark Inc. seeks a credentialing professional to coordinate and maintain delegated credentialing programs in compliance with NCQA, DPW, and DOH standards. You will oversee pre-delegation assessments, audits, and ongoing monitoring of recommendations and action plans.

Responsibilities include developing workflows, reporting, and communications with other departments to resolve barriers and ensure accurate data submission. Travel may be required.