Credentialing Specialist

Company: Blue Cross Blue Shield Of North Dakota
Location: Fargo
Posted on: January 16, 2020

Job Description:

Job Summary The Credentialing Specialist is responsible for reviewing, preparing and processing prospective Blue Cross Blue Shield of North Dakota (BCBSND) provider enrollment applications and participation agreements. This position handles any activities related to provider communications, credentialing, research and application approval duties, in a timely, detail oriented and professional manner. The Credentialing Specialist supports the credentialing and data-management day-to-day operations Essential Functions Prepares credentialing applications received daily, by transferring them into the system for processing, creating a credentialing case and assigning to the appropriate work queue. Performs credentialing, recredentialing or background check verification activities for prospective providers and does this through the use of telephone, email or appropriate internet sites. Adequately documents provider verifications in accordance with organizational and accreditation standards. Reviews provider applications and credentialing guidelines to make sure they are complete and accurate for the enrollment action being taken. Advises, educates and initiates necessary requests for information from providers regarding the details of what is missing, incorrect or conflicting for the application being processed. Utilizes computerized system to complete a variety of enrollment processing functions and handles data entry and research tasks. Requests any additional information in order to complete the credentialing/recredentialing processes. Answers questions regarding the application or the eligibility/credentialing status and creates approval notifications to providers as appropriate. Handles inbound phone calls and email correspondence from providers, credentialing agents, executive staff or any appropriate parties representing the provider group, in a professional and timely manner. Investigates provider files and payment discrepancies and other provider payment issues. Performs research designed to resolve claim processing issues by utilizing the appropriate reference materials and systems Attention to Detail and Accuracy Intermediate Flexibility and Adaptability Basic Time and Resource Management Basic Communication (Verbal/Written) Intermediate Continuous Learning/Development (Self) Basic Analytical Thinking Basic Education Required: High School Diploma/GED Preferred:Associate's Field(s) of Study: N/A Experience Required: Minimum of 2 Years Preferred:Minimum of 4 Years Experience Details: Minimum of 2 years of healthcare, insurance or related experience is required Title: N/A State or Agency: N/A Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards Other Information Job Posting Policy 6.05 New employees with Blue Cross Blue Shield of North Dakota will be eligible to apply for positions within their assigned department after successfully completing a 90-day review. For positions outside your department, you must attain a minimum of six months of service before you can apply. Equal Opportunity Employment Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity. For questions, please This job posting will be closed 1/15/2020 at 8:00AM CST. No further applications will be considered.

Keywords: Blue Cross Blue Shield Of North Dakota, Fargo , Credentialing Specialist, Other , Fargo, North Dakota