Strategic Credentialing & Delegation Analyst

Highmark Health; New York (NY); On-site; USD 32,000 - 49,000; Full time

Job summary

Highmark Inc. is seeking a Credentialing Specialist to coordinate and maintain delegated credentialing programs in line with NCQA, DPW, and DOH standards.

You will oversee pre-delegation assessments, annual audits, monitoring of recommendations, and maintenance of delegation agreements. Responsibilities include implementing GHP programs, monitoring performance against contracts, developing action plans, generating reports, and participating in committee meetings.

Qualifications

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

Responsibilities

• Coordinate delegated credentialing program per NCQA/DPW/DOH standards.
• Oversee delegation agreements and monitoring processes.
• Prepare evaluation reports on delegate performance, issues, deficiencies and recommendations.
• Attend delegation and GHP Committee meetings.
• Develop communication with other departments to resolve barriers.
• Ensure data collection and timely reporting.

Skills

Healthcare knowledge

Credentialing

Regulatory standards

Education

High school diploma / GED

Bachelor’s degree

Certified Provider Credentialing Specialist (CPCS) certification

Job description

Highmark Inc. is seeking a Credentialing Specialist to coordinate and maintain delegated credentialing programs in line with NCQA, DPW, and DOH standards.

You will oversee pre-delegation assessments, annual audits, monitoring of recommendations, and maintenance of delegation agreements. Responsibilities include implementing GHP programs, monitoring performance against contracts, developing action plans, generating reports, and participating in committee meetings.