Delegated Credentialing Analyst

Highmark Health; Elm (PA); In loco; USD 32.000 - 49.000; Tempo pieno

Descrizione del lavoro

Highmark Inc. coordinates and maintains a delegated credentialing program, ensuring compliance with NCQA, DPW, and DOH standards. The role oversees pre-delegation assessments, audits, and ongoing monitoring of recommendations and action plans while coordinating delegation agreements.

Responsibilities include monitoring delegate performance, reporting, and collaboration with GHP committees. Requires strong knowledge of credentialing standards and regulatory guidance.

Competenze

• 3 years of experience required 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.

Mansioni

• Coordinate and maintain delegated credentialing program in accordance with standards.
• Provide daily oversight of credentialing delegates to ensure compliance with policies and procedures.
• Establish and implement monitoring processes to evaluate performance against contract standards.

Conoscenze

Credentialing experience

NCQA standards

Formazione

High school diploma/GED

Bachelor’s degree

Descrizione del lavoro

Highmark Inc. coordinates and maintains a delegated credentialing program, ensuring compliance with NCQA, DPW, and DOH standards. The role oversees pre-delegation assessments, audits, and ongoing monitoring of recommendations and action plans while coordinating delegation agreements.

Responsibilities include monitoring delegate performance, reporting, and collaboration with GHP committees. Requires strong knowledge of credentialing standards and regulatory guidance.