Credential Delegation Analyst

Highmark Health

9d•$23 - $36

About The Position

JOB SUMMARY This job coordinates and maintains delegated credentialing program in accordance with GHP, NCQA, and all regulatory agency standards. This includes delegation program, policies/procedures, and all necessary compliance documentation. The incumbent coordinates, conducts, and evaluates all pre-delegation assessments, annual oversight audits, and the ongoing monitoring of recommendations and work plans. Coordinates and maintains all delegation agreements. ESSENTIAL RESPONSIBILITIES Implement GHP Programs. Facilitate problem resolution when needed. Provide daily oversight of credentialing delegates to ensure that the delegated entities meet all NCQA, DPW, and DOH, policies and procedures related to GHP’s delegated program. Establish and implement monitoring processes to evaluate performance against contract standards, requirements and performance expectations. Identify opportunities for improvement, barriers and facilitate problem resolution when necessary. Develop and monitor all delegates corrective action plans to assist and ensure compliance. Prepare an evaluation report of delegate performance, issues, deficiencies and recommendations for appropriate GHP personnel and committees review and approval. Develop communication processes with other GHP Departments to facilitate resolution of barriers identified with delegated services. Ensure mechanisms are in place to collect and submit required data. Analyze reports for timeliness on an ongoing basis. Design and generate reports based on special requests. Attend and participate in delegation and GHP Committee meetings. Participate in external meetings related to the functions/activities of the delegate program or department activities. Other duties as assigned or requested.

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

Nice To Haves

Bachelor’s degree.
Certified Provider Credentialing Specialist (CPCS) certification

Responsibilities

Implement GHP Programs.
Facilitate problem resolution when needed.
Provide daily oversight of credentialing delegates to ensure that the delegated entities meet all NCQA, DPW, and DOH, policies and procedures related to GHP’s delegated program.
Establish and implement monitoring processes to evaluate performance against contract standards, requirements and performance expectations.
Identify opportunities for improvement, barriers and facilitate problem resolution when necessary.
Develop and monitor all delegates corrective action plans to assist and ensure compliance.
Prepare an evaluation report of delegate performance, issues, deficiencies and recommendations for appropriate GHP personnel and committees review and approval.
Develop communication processes with other GHP Departments to facilitate resolution of barriers identified with delegated services.
Ensure mechanisms are in place to collect and submit required data.
Analyze reports for timeliness on an ongoing basis.
Design and generate reports based on special requests.
Attend and participate in delegation and GHP Committee meetings.
Participate in external meetings related to the functions/activities of the delegate program or department activities.
Other duties as assigned or requested.