Credentialing Enrollment Specialist

Blue Cross and Blue Shield of Kansas•Topeka, KS

22h•Hybrid

About The Position

The Credentialing Enrollment Specialist handles incoming telephone calls, emails, and written correspondence from professional providers or their designees about credentialing applications across all lines of business. The specialist serves as a resource for Provider Network Services, Reimbursement Records, and internal customers of provider records, and answers providers’ questions about credentialing requirements. The role reviews credentialing applications against mandatory health plan accreditation elements for accuracy and completeness before Corporate Credentialing Committee review. It includes preparing files for committee review, obtaining missing information or updated CAQH applications, performing primary source verification, maintaining credentialing records, and coordinating provider enrollment after credentialing is complete. All work must comply with applicable accreditation, corporate, and federal requirements. The position is eligible to be hybrid or onsite under the company’s Telecommuting Policy. Applicants must reside in Kansas or Missouri, or be willing to relocate as a condition of employment. The position is mostly stationary, with approximately 85% of the workday spent using a PC. There may be an option to work from home if deadlines are consistently 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.
Ability to work independently and cooperatively in a team setting.
Ability to focus on details and rapidly switch tasks to complete varied work items within prescribed deadlines.
Ability to independently determine an appropriate approach to solving problems.
Ability to maintain strict confidentiality and comply with the Corporate Compliance Program and applicable accreditation standards.

Nice To Haves

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

Responsibilities

Review credentialing applications and prepare files for Corporate Credentialing Committee review.
Contact providers or their designees to obtain missing information and update expired CAQH applications.
Complete primary source verification, including verification of licenses, board certification, Medicare/Medicaid sanction activity through OIG, National Practitioner Data Bank information, professional liability coverage, and accreditation status.
Provide timely and 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 information into the credentialing system and coordinate enrollment processing within the operations division after credentialing is complete.
Monitor, record, and assign incoming paper credentialing applications.
Understand and interpret credentialing compliance rules and regulations and apply them to applications and processing.
Complete credentialing activities in accordance with accreditation standards and accreditation, corporate, and federal compliance requirements.
Handle incoming 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.
Maintain strict confidentiality when preparing and handling confidential documents.
Complete annual accreditation standards education and training relevant to job functions.

Benefits

Paid vacation and sick leave available immediately upon hire.
Paid maternity and paternity leave available immediately upon hire.
Incentive pay program (EPIP).
Health, vision, and dental insurance.
Six weeks of paid parental leave for new mothers and fathers.
Fertility and adoption assistance.
Two weeks of paid caregiver leave.
401(k) plan with matching up to 5%.
Tuition reimbursement.
Health and fitness benefits, discounts, and resources.
Ongoing training and development programs.
Flexible work environment; hybrid or onsite work eligibility under the Telecommuting Policy.