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Highmark Health este o organizație din domeniul sănătății, axată pe îmbunătățirea modului în care oamenii accesează și experimentează serviciile de îngrijire medicală. Activitatea sa cuprinde servicii clinice, tehnologie, finanțe, marketing și alte funcții care sprijină furnizarea de servicii medicale. În calitate de licențiat independent al Blue Cross Blue Shield Association, compania reunește o gamă largă de profesioniști pentru a contribui la evoluția sistemului de sănătate. Highmark Health pune, de asemenea, accent pe diversitate, echitate și incluziune și a fost recunoscută pentru incluziunea persoanelor cu dizabilități și pentru statutul de angajator favorabil membrilor și veteranilor forțelor armate.
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.
Descriere
- 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
Cerințe
- 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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