Credential Delegation Analyst

Location: Remote work from Pennsylvania, United States

Company

hirify.global provides health insurance and managed care services through its GHP delegated credentialing program.

What you will do

• Implement GHP delegated credentialing programs and maintain related policies, procedures, agreements, and compliance documentation.
• Provide daily oversight of credentialing delegates and evaluate compliance with NCQA, DPW, DOH, and contractual standards.
• Coordinate pre-delegation assessments, annual oversight audits, ongoing monitoring, and performance evaluations.
• Develop monitoring processes, corrective action plans, reports, and recommendations for GHP personnel and committees.
• Analyze data and reports for timeliness, generate reports for special requests, and ensure required data is collected and submitted.
• Facilitate resolution of issues and barriers with GHP departments and participate in internal and external delegation-related meetings.

Requirements

• Must work remotely from Pennsylvania, United States.
• High school diploma or GED.
• At least three years of experience in healthcare or managed care.
• At least three years of experience with practitioner or provider credentialing and re-credentialing.
• At least three years of experience with NCQA and other regulatory standards.

Nice to have

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

Culture & Benefits

• Remote work arrangement from Pennsylvania.
• Travel is required.
• Work includes participation in GHP and delegation committee meetings.
• Responsibilities require compliance with HIPAA, information security policies, the Code of Business Conduct, and applicable laws and regulations.