Credentialing Manager

BlueCross BlueShield of South Carolina•W@H South Carolina, SC

2d•Remote

About The Position

We are currently hiring for a Credentialing Manager to join BlueCross BlueShield of South Carolina. In this role as a Credentialing Manager, you will be responsible for the management of all provider credentialing activities/credentialing program for commercial business, Medicare, Medicaid, and delegated credentialing for all BCBSSC lines of business. This position will also be responsible for designing and implementing process improvements to the credentialing process to include but not limited to system enhancements.

Requirements

Bachelor's in a job-related field
5 years healthcare experience to include healthcare program management, provider network, contracting or credentialing, managed care, medical education training, or physician office management
2 of the 5 years must have been in supervisory role or equivalent military experience in grade E4 or above.
Knowledge/understanding of NCQA and JCAHO credentialing standards, credentialing/recredentialing process for healthcare practitioners and ancillary/institutional providers.
Knowledge of medical terminology.
Ability to work independently, prioritize effectively, make sound decisions.
Good judgment skills.
Demonstrated customer service, organizational, and presentation skills.
Demonstrated verbal and written communication skills.
Analytical or critical thinking skills.
Ability to direct, motivate, and assess performance of others.

Nice To Haves

Must have a strong background in developing credentialing processes, system deployments, and workforce management.

Responsibilities

Manages day-to-day operations of credentialing area to include delegated credentialing activities.
Develops/implements credentialing policies/procedures/evaluation tools.
Evaluates/monitors/ensures compliance with National Committee of Quality Assurance (NCQA) and other regulatory standards/external review bodies.
Conducts on-site audits and inspections of delegated entities/provider files.
Communicates with/responds to internal and external representatives regarding data, delegation agreements, facility credentialing, and sanction issues.
Works with other departments to address/resolve credentialing issues.
Promotes efficiency through planning, problem solving, and application of industry standards.
Maintains accurate/current/efficient databases.
Coordinates/manages all activities and follows-up for credentialing committee.
Presents physicians/practitioners/providers with quality issues to committee for review.
Selects/trains/develops/guides staff and ensures excellent customer service is given to employees/customers/management, etc.
Monitors department performance and productivity.
Performs quality control functions for work performed.
Makes recommendations on process improvements and identifies training needs for staff.