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 state-specific regulations
• Coordinate with various departments to ensure efficient credentialing and contracting of clinicians

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 (e.g., Modio, CAQH, Availity)
• CPCS or CPMSM certification (or working toward it) is preferred