Credentialing Coordinator - (Remote in Arizona)

Blue Cross Blue Shield of Arizona•Phoenix, AZ

1d•Remote

About The Position

The Credentialing Coordinator facilitates the accurate and efficient Credentialing and Recredentialing of Medicaid Business Segment providers in alignment with State, Federal, and NCQA standards. This is a remote position within the state of Arizona only, requiring residency and work to be performed within the State of Arizona. The company, Blue Cross Blue Shield of Arizona, aims to inspire health and make it easy, offering various health insurance products and services. They have a hybrid workforce strategy called Workability, offering flexibility with how and where employees work. This specific role has an onsite expectation of 0 days per week and requires a full-time work schedule, defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.

Requirements

2 years of experience in a healthcare field
2 years of experience in provider credentialing
High-School Diploma or GED in general field of study
Verbal and written communication skills
Maintains confidentiality according to policy
Effectively communicate with internal and external customers via telephone and email
Accurately receive information through oral communication
Accurately review data and figures both in hard copy and electronic formats
Accurately sort through data and think through issues in a time‐pressured environment
Accurately learn and retain new information, knowledge, and skills
Efficiently manage multiple tasks, with varying degrees of priority, at the same time
Ability to think critically
Strong attention to detail
Excellent organizational skills
Outstanding interpersonal skills, ability to establish a trusting rapport with individuals at all levels
Maintain a calm and collected presence while addressing the concerns from an internal and external customer
Residency within the State of Arizona
Work to be performed within the State of Arizona

Nice To Haves

2 years of experience in a healthcare field, preferably within a credentialing/recredentialing environment and knowledge of national accreditation and/or regulatory standards
Associate's Degree in general field of study
Certified Provider Credentialing Specialist (CPCS)
Thorough understanding of managed care principles and physician practice operations, with an understanding of health plan credentialing preferred

Responsibilities

Ensure timely and accurate processing of credentialing and recredentialing for both individual practitioners and organizations
Coordinate Credentialing Committee meeting, including preparing the agenda and documenting meeting minutes
Identify and communicate agenda items for Credentialing Committee to immediate leader
Facilitate prompt coordination with the Credentialing Verification Organization (CVO) and monitor Work in Progress file
Promptly address incoming files for processing
Review and maintain all applications for accuracy and completeness
Accurately and efficiently data enter primary source verification data into the credentialing database
Input credentialing decisions and dates into the credentialing database
Generate and mail approval letters to participating providers
Identify missing or erroneous information from the provider’s application, and communicate with the provider to obtain
Coordinate with Network Services and/or other internal departments on follow-up items needed to complete the credentialing process
Communicate with Network Services and/or other internal departments regarding status of provider and organizational credentialing
Maintain ongoing participation in cross-training activities
Provide recommendations and feedback regarding process improvements and/or standardization practices
Actively participate in staff meetings, team huddles, and one-on-one meetings
Engage in team building activities
Perform all other duties as assigned