Credential Delegation Analyst

Company : reputed company.Job Description : JOB SUMMARY This job coordinates and maintains delegated credentialing program in accordance with GHP, NCQA, and reputed company regulatory agency standards. This includes delegation program, policies/procedures, and reputed company necessary compliance documentation. The incumbent coordinates, conducts, and evaluates reputed company pre-delegation assessments, annual reputed company audits, and the ongoing monitoring of recommendations and work plans. Coordinates and maintains reputed company delegation agreements. ESSENTIAL RESPONSIBILITIES

• Implement GHP Programs.
• Facilitate problem resolution reputed company needed.
• Provide daily reputed company of credentialing delegates to ensure that the delegated entities meet reputed company NCQA, DPW, and DOH, policies and procedures reputed company 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 reputed company necessary.
• reputed company and monitor reputed company 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.
• reputed company communication processes with other GHP Departments to facilitate resolution of barriers identified with delegated services.
• Ensure mechanisms are in reputed company 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 reputed company to the functions/activities of the delegate program or department activities.
• Other duties as assigned or requested.

QUALIFICATIONS Required

• 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

Substitutions

• None

Preferred

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

Skills

• None

SCOPE OF RESPONSIBILITY Does this role supervise/manage other employees? No WORK ENVIRONMENT Is Travel Required? Yes Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times. In reputed company with this, reputed company employees must reputed company with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as reputed company data reputed company guidelines established reputed company the Company’s Handbook of Privacy Policies and Practices and Information reputed company Policy. Furthermore, it is every employee’s responsibility to reputed company with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $23.16Pay Range Maximum: $35.88 reputed company pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential reputed company may apply for certain locations based upon comparative markets. reputed company and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against reputed company individuals based on any category protected by applicable federal, state, or local law. We endeavor to reputed company this site accessible to any and reputed company users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at [email protected] California Consumer Privacy Act Employees, Contractors, and Applicants Notice Apply tot his job Apply To this Job