Credentialing Enrollment Specialist

Job Summary

Responsible for the prompt, courteous, accurate, and timely handling of incoming telephone calls, emails, and written correspondence from professional providers, or their designees, covering all lines of business regarding their credentialing application. Serve as a resource for Provider Network Services, Reimbursement Records, and internal customers of provider records. Directly engage with providers and their designees regarding questions related to credentialing.

Responsibilities

• Review credentialing applications and prepare files for the Corporate Credentialing Committee.
• Involves, but not limited to, outreach to providers or their designees to obtain missing information and/or update expired CAQH application.
• Complete primary source verification including license, board certification, Medicare/Medicaid sanction activity (OIG), National Practitioner Data Bank, professional liability coverage, and accreditation status.
• Provide education and answer questions timely and accurately for providers or their designees regarding credentialing requirements.
• Add providers to the CAQH Roster prior to providers' 36-month recredentialing deadline.
• Complete credentialing system record entry, coordinate enrollment processing within operations division to complete network enrollment after credentialing completion.
• Maintain confidentiality of co-fidential documents.
• Rapidly switch tasks to complete diversified work items within prescribed deadlines.
• Follow required accreditation standards education/training on job functions that is included as part of the adopted and in place health plan accreditation.
• Complete annual accreditation standards education/training on job functions that is included as part of the adopted and in place health plan accreditation.
• Follow required Education And Experience accreditation standards as required for essential job functions.

Requirements

• High school graduate or equivalent required with additional education in communications, human relations, or medical terminology.
• One year of operational experience within BCBSKS to include customer services, claims or membership, or 2 years demonstrated experience working with medical insurance or provider licensing is strongly preferred.
• Strong computer skills to operate effectively within the credentialing system.

Benefits & Perks

• Base compensation is only one component of your competitive Total Rewards package.
• Incentive pay program (EPIP).
• Health/Vision/Dental insurance.
• 6 weeks paid parental leave for new mothers and fathers.
• Fertility/Adoption assistance.
• 2 weeks paid caregiver leave.
• 401(k) plan matching up to 5%.
• Tuition reimbursement.
• Health & fitness benefits, discounts and resources.