Credentialing Specialist

BlueCross BlueShield of South Carolina

1d•Remote

About The Position

We are currently hiring for a Credentialing Specialist to join BlueCross BlueShield of South Carolina. In this role as a Credentialing Specialist, you will be responsible for the completion of the initial credentialing and re-credentialing process of providers to the network for various lines of business across the company. Maintains credentialing database and ensures provider databases are current and accurate. Provides assistance to network staff, providers, contract services, marketing, and medical affairs. Ensures compliance with external review organization standards and delegation agreements. Location This position is full-time (40 hours/week) Monday-Friday from 8:30am – 5:00pm and will be fully remote.

Requirements

Associate's degree
2 years job related work experience.
2 years experience in the healthcare or insurance industry.
Good judgment skills.
Effective organizational, customer service skills.
Demonstrated verbal and written communications skills.
Demonstrated proficiency in spelling, punctuation, and grammar skills.
Ability to handle confidential or sensitive information with discretion.
Knowledge or the ability to acquire of organization/committee standards, delegation agreements, etc.
Microsoft Office.

Responsibilities

Performs initial and re-credentialing of providers/practitioners including documenting credentialing information according to established policies/procedures.
Completes primary verification of the following: state licensure, state/federal controlled substance certification, educational and/or residency background, malpractice coverage/history, hospital privileges, and previous sanctions.
Maintains credentialing database and HCS data files with appropriate network indicators and effective dates.
Ensures provider databases are kept current and accurate.
Retrieves and interprets credentialing database information for use in various reports.
Communicates (both verbally and in written form) with providers, provider relations, marketing, other credentialing departments, and various management staff relating to any urgent matters.
Registers all participating providers and assists provider network personnel in maintaining and/or updating directory information.
Responds to calls/correspondence from physician/provider/office staff regarding participating networks, directories, and provider credentialing.
Ensures communication of provider profiling and performance information with other provider services areas.
Prepares correspondence and credentialing reports as requested by management.
Assembles necessary information on providers due initial credentialing or re-credentialing for presentation to credentialing committee.
Attends meetings of credentialing committee as scheduled.
Assists in research, redevelopment, and implementation of any new programs/projects.
Provides administrative support to delegated credentialing activities.