Credentialing Enrollment Specialist

Blue Cross and Blue Shield of Kansas•Topeka, KS

1d•$24 - $29•Hybrid

About The Position

The Credentialing Enrollment Specialist handles incoming telephone calls, emails, and written correspondence from professional providers and their designees about credentialing applications across all lines of business. The role serves as a resource for Provider Network Services, Reimbursement Records, and internal customers of provider records, and engages directly with providers to address credentialing questions. It reviews applications for accuracy and completeness against mandatory health plan accreditation elements before Corporate Credentialing Committee review for network enrollment and participation. The position prepares credentialing files, performs primary source verification, maintains credentialing records, and coordinates enrollment processing after credentialing is complete. Activities must comply with accreditation standards and applicable corporate and federal requirements. The position is eligible to be hybrid or onsite under the company telecommuting policy. Applicants must reside in Kansas or Missouri, or be willing to relocate as a condition of employment. The work is mostly stationary, includes handling incoming calls and using a PC for approximately 85% of the workday, and requires minimal lifting. Working from home may be an option if deadlines are continuously met.

Requirements

High school graduate or equivalent.
Additional education in communications, human relations, or medical terminology.
Strong computer skills to operate company systems and programs effectively.
Excellent verbal and written communication and human relations skills, with the ability to interact positively with internal and external peers at all levels.
Ability to work under pressure and meet deadlines.
Good organizational and multitasking skills, and ability to work independently and cooperatively within a team.
Ability to maintain strict confidentiality when preparing confidential documents.
Ability to independently determine an appropriate approach to solving problems.
Ability to focus on details and rapidly switch tasks to complete diverse work within prescribed deadlines.
Must comply with the Corporate Compliance Program.
Must complete annual accreditation standards education and training and follow required accreditation standards for essential job functions.
Must reside in Kansas or Missouri, or be willing to relocate as a condition of employment.

Nice To Haves

One year of operational experience within BCBSKS in customer service, claims, or membership.
Two years of demonstrated experience working with medical insurance or provider licensing.

Responsibilities

Review credentialing applications and prepare files for Corporate Credentialing Committee review, including contacting providers or their designees for missing information or to update expired CAQH applications.
Complete primary source verification of licenses, board certification, Medicare/Medicaid sanction activity (OIG), National Practitioner Data Bank records, professional liability coverage, and accreditation status.
Provide timely, accurate education and answers to providers or their designees about credentialing requirements.
Add providers to the CAQH Roster before their 36-month recredentialing deadline.
Enter records in the credentialing system and coordinate enrollment processing within the operations division to complete network enrollment after credentialing.
Monitor, record, and assign incoming paper credentialing applications.
Interpret credentialing compliance rules and regulations and apply them to applications and processing.
Complete credentialing activities according to accreditation standards and applicable accreditation, corporate, and federal compliance requirements.
Handle incoming provider calls, emails, and written correspondence courteously, accurately, and promptly.
Serve as a resource for Provider Network Services, Reimbursement Records, and internal customers of provider records.