Provide subject matter expertise to the Corporate Credentialing and Program Support Department team with the credentialing and recredentialing policies, procedures and processes.
Perform credentialing/recredentialing activities and other responsibilities of credentials coordinator in addition to lead role.
Provide subject matter expertise to credentialing team; produce and analyze credentialing activity reports; report on issues identified.
Assist leadership team with data collection to prepare quality-related credentialing processing reports to ensure compliance with accreditation and regulatory requirements.
Act as liaison between the Corporate Credentialing and Program Support Department and other operational areas in identifying problem areas/issues.
Assist with the development and delivery of credentials coordinator technical and operational training sessions and on-the-job training.
Assist with the preparation of credentialing files and reports that require Medical Director or Credentials Committee approval.
Produce and analyze credentialing activity reports and report on issues to ensure compliance with accreditation and regulatory requirements.
Maintain solid understanding of BCN AND BCBSM credentialing policies, procedures and processes
Maintain solid understanding of credentialing/provider/financial affiliation screens and related BCBSM systems.
Troubleshoots and resolves issues that may arise between the credentialing staff, the provider network and CAQH.
Department Summary / Preferences:
Credentialing experience required
" Qualifications"
Minimum of a two (2) year Associates Degree in a health or business related field preferred.
Five (5) years work experience as a credentials coordinator in managed care credentialing preferred.
Knowledge of related state/federal regulations, NCQA, DIFS ,MDHHS and CMS standards for credentialing required.
Knowledge of PORTICO and other PC software and spreadsheet applications required.
Must be able to work in a lead role independently and manage multiple priorities.
Excellent interpersonal skills and the ability to interact with internal/external customers.
Strong verbal, written communication and organizational skills.
Strong proficiency in industry standard PC applications and systems (i.e. Excel, Word).
Highly organized, motivated and responsible self-starter.
Excellent time-management, analytical and problem solving skills.
All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.
Equal Opportunity Employer–minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity
Please see job description for required skills.