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Highmark Health is a healthcare organization focused on improving how people experience and access care. Its work spans clinical services, technology, finance, marketing, and other functions that support the delivery of healthcare. As an independent licensee of the Blue Cross Blue Shield Association, the company brings together a broad range of professionals to help evolve the healthcare system. Highmark Health also highlights diversity, equity, and inclusion, with recognition for disability inclusion and military-friendly employment.
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.
Description
- 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
Requirements
- 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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