Credentialing & Delegation Compliance Analyst

Highmark Health; Pennsylvania; Hybrid; USD 32,000 - 49,000; Full time

Job summary

Highmark Health in Pittsburgh, PA, seeks a credentialing coordinator to oversee delegated credentialing programs in line with GHP, NCQA and regulatory standards. You will supervise pre-delegation assessments, annual audits and ongoing monitoring of recommendations and action plans.

Responsibilities include developing monitoring processes, preparing evaluation reports, coordinating with GHP departments and participating in delegated service committees to ensure compliance and timely data

Qualifications

• High school diploma or GED required.
• Three years of experience in health care/managed care.
• Three years of credentialing/re-credentialing of practitioners/providers.
• Three years of NCQA and other regulatory standards experience.

Responsibilities

• Coordinate implementation and oversight of GHP credentialing programs.
• Provide daily oversight of credentialing delegates to meet NCQA, DPW, and DOH standards.
• Develop and monitor corrective action plans for delegates.
• Prepare evaluation reports on delegate performance and recommendations.
• Develop communication with other GHP departments to resolve barriers.
• Attend delegation and GHP Committee meetings and external meetings as needed.

Education

High school diploma / GED

Bachelor’s degree (preferred)

Job description

Highmark Health in Pittsburgh, PA, seeks a credentialing coordinator to oversee delegated credentialing programs in line with GHP, NCQA and regulatory standards. You will supervise pre-delegation assessments, annual audits and ongoing monitoring of recommendations and action plans.

Responsibilities include developing monitoring processes, preparing evaluation reports, coordinating with GHP departments and participating in delegated service committees to ensure compliance and timely data