Credential Delegation Analyst

Job description

Company: Highmark Inc. Job Description: 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...