Highmark Health
Highmark Health
Highmark Health — адамдардың медициналық көмекті алу және оны қабылдау тәжірибесін жақсартуға бағытталған денсаулық сақтау ұйымы. Оның қызметі медициналық көмекті ұсынуды қолдайтын клиникалық қызметтерді, технологияны, қаржыны, маркетингті және басқа да функцияларды қамтиды. Blue Cross Blue Shield Association ұйымының тәуелсіз лицензия иесі ретінде компания денсаулық сақтау жүйесін дамытуға үлес қосу үшін әртүрлі салалардағы көптеген мамандардың басын біріктіреді. Highmark Health сонымен қатар әртүрлілікке, теңдікке және инклюзияға мән береді, мүгедектігі бар адамдарды қамту және әскери қызметшілерге қолайлы жұмыс беруші болу бағыттарындағы мойындалуымен ерекшеленеді.

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.

Сипаттама

  • 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

Талаптар

  • 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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