Credential Delegation Analyst

Highmark Health

. Coordinate and maintain the delegated credentialing program in accordance with GHP, NCQA, and regulatory agency standards .

Posted 10/5/2026full-timeRemote • Pennsylvania • United StatesMid-LevelSenior💰 $23 - $36 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in coordinating credentialing programs in compliance with GHP, NCQA, and regulatory standards, while effectively managing performance evaluations and corrective action plans for delegates.

Highest-signal resume keywords

Credentialing/Re-Credentialing ExperienceNCQA ComplianceCorrective Action Plan DevelopmentDelegation Program ManagementCertified Provider Credentialing Specialist (CPCS)

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

CredentialingCompliance DocumentationPerformance EvaluationData AnalysisReport GenerationPre-Delegation AssessmentsOversight AuditsMonitoring ProcessesProblem ResolutionDelegation Agreements

Soft Skills

CommunicationProblem-SolvingCollaborationOrganizational SkillsAttention to Detail

Certifications & Qualifications

Certified Provider Credentialing Specialist (CPCS)

Industry Keywords

Health CareManaged CareRegulatory StandardsGHPNCQA

About the role

Key responsibilities & impact

Coordinate and maintain the delegated credentialing program in accordance with GHP, NCQA, and regulatory agency standards
Maintain delegation program policies/procedures and compliance documentation
Coordinate, conduct, and evaluate pre-delegation assessments and annual oversight audits
Monitor recommendations and work plans
Coordinate and maintain delegation agreements
Implement GHP programs
Facilitate problem resolution
Provide daily oversight of credentialing delegates
Establish and implement monitoring processes to evaluate performance against contract standards and expectations
Identify improvement opportunities and barriers
Develop and monitor corrective action plans for delegates
Prepare evaluation reports of delegate performance, issues, deficiencies, and recommendations
Develop communication processes with other GHP departments
Ensure required data is collected and submitted
Analyze reports for timeliness
Design and generate reports based on special requests
Attend delegation and GHP Committee meetings and relevant external meetings
Perform other duties as assigned

Requirements

What you’ll need

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
Ability to travel
Bachelor’s degree preferred
Certified Provider Credentialing Specialist (CPCS) certification preferred