Delegated Credentialing Specialist

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

May 29, 2025 - 08:30

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