Credentialing specialist

BlueCross BlueShield of South Carolina•Columbia, SC

34d•Onsite

About The Position

Summary 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. Description Logistics This position is (40 hours/week) Monday-Friday and will be located at 4101 Percival Road, Columbia, S.C., 29219. What You Will Do: 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.

Requirements

Associate degree OR two years of related work experience.
Two years’ experience in the healthcare OR insurance industry.
Good judgment skills.
Effective organizational and 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.

Nice To Haves

Prior credentialing experience

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.

Benefits

401(k) retirement savings plan with company match
Subsidized health plans and free vision coverage
Life insurance
Paid annual leave – the longer you work here, the more you earn
Nine paid holidays
On-site cafeterias and fitness centers in major locations
Wellness programs and healthy lifestyle premium discount
Tuition assistance
Service recognition
Incentive Plan
Merit Plan
Continuing education funds for additional certifications and certification renewal