Highmark Health
Highmark Health
Highmark Health एक स्वास्थ्य सेवा संगठन है, जिसका ध्यान लोगों के लिए स्वास्थ्य सेवाओं के अनुभव और उन तक पहुंच को बेहतर बनाने पर है। इसका कार्य नैदानिक सेवाओं, प्रौद्योगिकी, वित्त, विपणन और स्वास्थ्य सेवाओं के वितरण में सहायक अन्य कार्यों तक फैला हुआ है। Blue Cross Blue Shield Association के एक स्वतंत्र लाइसेंसधारी के रूप में, कंपनी स्वास्थ्य सेवा प्रणाली को विकसित करने में सहायता करने के लिए विभिन्न क्षेत्रों के पेशेवरों को साथ लाती है। Highmark Health विविधता, समानता और समावेशन को भी महत्व देती है तथा दिव्यांग समावेशन और सैन्य-अनुकूल रोजगार के लिए मान्यता प्राप्त कर चुकी है।

Credential Delegation Analyst - Pennsylvania Remote

Credentialing analyst responsible for Highmark Health’s delegated healthcare credentialing programs, including oversight audits, compliance records, corrective action plans, and regulatory reporting.

विवरण

  • Manage the delegated credentialing program in line with GHP, NCQA, and regulatory agency requirements
  • Maintain delegation policies, procedures, and compliance records
  • Coordinate and assess pre-delegation reviews and annual oversight audits
  • Track recommendations and associated work plans
  • Maintain delegation agreements
  • Implement GHP programs
  • Support resolution of credentialing-related issues
  • Provide daily oversight of credentialing delegates
  • Create monitoring processes to measure performance against contractual standards and expectations
  • Identify process improvements and obstacles
  • Create and track delegate corrective action plans
  • Produce reports on delegate performance, issues, deficiencies, and recommendations
  • Establish communication procedures with other GHP departments
  • Confirm required data is collected and submitted
  • Review reports for timeliness
  • Create reports in response to special requests
  • Participate in delegation, GHP Committee, and relevant external meetings
  • Complete additional assigned duties

आवश्यकताएँ

  • High school diploma or GED
  • At least three years of healthcare or managed care experience
  • At least three years of practitioner or provider credentialing and re-credentialing experience
  • At least three years of experience applying NCQA and other regulatory standards
  • Ability to travel
  • Bachelor’s degree preferred
  • Certified Provider Credentialing Specialist (CPCS) certification preferred

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