Delegated Credentialing Specialist

Job Summary

A company is looking for a Delegated Credentialing Specialist responsible for managing the delegated credentialing process for behavioral health clinicians.

Key Responsibilities

• Manage the full lifecycle of delegated credentialing, including initial credentialing and ongoing monitoring
• Ensure compliance with NCQA credentialing requirements and serve as the primary contact for delegated agreements with health plans
• Coordinate with various departments to ensure efficient credentialing and resolve issues related to provider data

Required Qualifications

• 3+ years of credentialing experience in a healthcare setting, with at least 1 year focused on delegated credentialing agreements
• Strong understanding of NCQA standards and state Medicaid credentialing rules
• Experience in behavioral health or outpatient ambulatory care organizations
• Proficient with credentialing systems such as Modio or CAQH
• CPCS or CPMSM certification (or working toward it) is preferred