Remote Credentialing & Delegation Analyst

Highmark Health; Northern (KY); Hybrid; USD 32,000 - 49,000; Full time

Job summary

Highmark Inc. is seeking a Credential Delegation Analyst to coordinate and maintain delegated credentialing programs in accordance with GHP, NCQA, and regulatory standards.

You will oversee pre-delegation assessments, annual oversight audits, and ongoing monitoring of recommendations and work plans, and manage delegation agreements. Responsibilities include implementing GHP programs, providing daily oversight of credentialing delegates, establishing monitoring processes, identifying improvement

Qualifications

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

Responsibilities

• Coordinate and maintain delegated credentialing program per GHP/NCQA standards.
• Provide daily oversight of credentialing delegates to meet NCQA/DPW/DOH policies.
• Establish monitoring processes to evaluate performance against contract standards and requirements.
• Develop and monitor delegates' corrective action plans for compliance.
• Prepare evaluation reports on delegate performance and issues for leadership review.
• Attend delegation and GHP committee meetings and participate in related external meetings.

Education

Bachelor’s degree

High school diploma/GED

Job description

Highmark Inc. is seeking a Credential Delegation Analyst to coordinate and maintain delegated credentialing programs in accordance with GHP, NCQA, and regulatory standards.

You will oversee pre-delegation assessments, annual oversight audits, and ongoing monitoring of recommendations and work plans, and manage delegation agreements. Responsibilities include implementing GHP programs, providing daily oversight of credentialing delegates, establishing monitoring processes, identifying improvement