Credential Delegation Analyst

Job not on LinkedIn

🔥 2 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $23 - $35 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Highmark Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1852

🛡️ Insurance

💼 Consulting

📦 Logistics

💰 $5M Grant on 2021-05

Insurance • Consulting • Logistics

Highmark Health is a healthcare company committed to reinventing the healthcare system and improving its services for everyone. The organization offers a broad range of career opportunities across various fields such as clinical care, technology, finance, and marketing. Highmark Health emphasizes diversity, equity, and inclusion in its workforce, creating a supportive environment for employees from all backgrounds. The company has been recognized for its commitment to disability inclusion, diversity, and military-friendly employment. As an independent licensee of the Blue Cross Blue Shield Association, Highmark Health strives to create remarkable healthcare experiences for its customers and employees alike.

📋 Description

• Coordinate and maintain the delegated credentialing program in accordance with GHP, NCQA, and regulatory agency standards • Maintain delegation program policies/procedures and compliance documentation • Coordinate, conduct, and evaluate pre-delegation assessments and annual oversight audits • Monitor recommendations and work plans • Coordinate and maintain delegation agreements • Implement GHP programs • Facilitate problem resolution • Provide daily oversight of credentialing delegates • Establish and implement monitoring processes to evaluate performance against contract standards and expectations • Identify improvement opportunities and barriers • Develop and monitor corrective action plans for delegates • Prepare evaluation reports of delegate performance, issues, deficiencies, and recommendations • Develop communication processes with other GHP departments • Ensure required data is collected and submitted • Analyze reports for timeliness • Design and generate reports based on special requests • Attend delegation and GHP Committee meetings and relevant external meetings • Perform other duties as assigned

🎯 Requirements

• High school diploma /GED • 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 • Ability to travel • Bachelor’s degree preferred • Certified Provider Credentialing Specialist (CPCS) certification preferred