Credentialing Enrollment Specialist

Kansas Inc.; Topeka (KS); Hybrid; USD 33,000 - 40,000; Full time

Benefits offered by this job

Health insurance

Vision/Dental insurance

6 weeks parental leave

Fertility/Adoption assistance

2 weeks caregiver leave

401(k) plan matching up to 5%

Tuition reimbursement

Health & fitness benefits

Job summary

Blue Cross and Blue Shield of Kansas is seeking a credentialing specialist to handle provider credentialing applications across lines of business. You will review applications, perform verifications, coordinate with internal teams, and ensure accuracy prior to committee review.

Hybrid or onsite work in Kansas or Missouri is eligible, with relocation possible. Applicants should have healthcare terminology knowledge, strong confidentiality, and the ability to manage deadlines.

Qualifications

• Knowledge of credentialing processes and databases.
• Experience with CAQH and provider records handling.
• Ability to maintain confidentiality and follow compliance.

Responsibilities

• Review credentialing applications and prepare files for committee.
• Contact providers to obtain missing information.
• Perform primary source verification (license, board certs, sanctions).
• Educate providers on credentialing requirements and timelines.
• Add providers to CAQH roster before recredentialing deadlines.
• Coordinate network enrollment after credentialing completion.

Skills

Credentialing

CAQH roster

Quality assurance

Confidentiality

Education

High school diploma

Healthcare terminology training

Job description

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

Why Join Us?

Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.

Family Comes First: Total rewards package that promotes the idea of family first for all employees.

Paid vacation and sick leave with paid maternity and paternity available immediately upon hire

Professional Growth Opportunities: Advance your career with ongoing training and development programs.

Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility.

Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community.

Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected.

Benefits & Perks

• Base compensation is only one component of your competitive Total Rewards package
• Incentive pay program (EPIP)
• Health/Vision/Dental insurance
• 6 weeks paid parental leave for new mothers and fathers
• Fertility/Adoption assistance
• 2 weeks paid caregiver leave
• 401(k) plan matching up to 5%
• Tuition reimbursement
• Health & fitness benefits, discounts and resources

Job Summary

Responsible for the prompt, courteous, accurate, and timely handling of incoming telephone calls, emails, and written correspondence from professional providers, or their designees, covering all lines of business regarding their credentialing application.

Serve as a resource for Provider Network Services, Reimbursement Records, and internal customers of provider records.

Directly engage with providers and their designees regarding questions related to credentialing.

Responsible for reviewing credentialing application against mandatory health plan accreditation elements to ensure accuracy and completeness prior to Corporate Credentialing Committee review for network enrollment and participation.

“This position is eligible to work hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.”

What you’ll do

• Responsible for reviewing credentialing applications and preparing files for the Corporate Credentialing Committee.
• Involves, but not limited to, outreach to providers or their designees to obtain missing information and/or update expired CAQH application.
• Complete primary source verification including license, board certification, Medicare/Medicaid sanction activity (OIG), National Practitioner Data Bank, professional liability coverage, and accreditation status.
• Provides education and answers questions timely and accurately for providers or their designees regarding credentialing requirements.
• Responsible for adding providers to the CAQH Roster prior to providers 36-month recredentialing deadline.
• Complete credentialing system record entry, coordinate enrollment processing within operations division to complete network enrollment after credentialing completion.
• Monitors, records, and assigns incoming paper credentialing applications.
• Understand and interpret credentialing compliance rules and regulations and apply to credentialing applications and processing.
• All credentialing activities must be completed according to accreditation standards and be aligned with accreditation, corporate, and federal compliance requirements.

What you need

Knowledge/Skills/Abilities

• Responsible for preparing confidential documents and must maintain strict confidentiality.
• Independently determines best approach to solving problems.
• Ability to focus on details with the ability to rapidly switch tasks to complete diversified work items within prescribed deadlines.
• Must comply with Corporate Compliance Program to ensure proven network value and integrity.
• Must complete annual accreditation standards education/training on job functions that is included as part of the adopted and in place health plan accreditation.
• Must be able to follow required accreditation standards as required for essential job functions.

Education and Experience

• High school graduate or equivalent required with additional education in communications, human relations, or medical terminology.
• One year of operational experience within BCBSKS to include customer services, claims or membership, or 2 years demonstrated experience working with medical insurance or provider licensing is strongly preferred.
• Strong computer skills to operate effectively with company systems and programs.
• Excellent verbal and written communication and human relation skills with the ability to interact positively at all levels of internal and external peers.
• Ability to work well under pressure and meet deadlines.
• Work requires good organizational and multi-tasking skills and ability to work both independently and cooperatively within team setting.

Physical Requirements

Position is mostly stationary involving the handling of incoming phone calls and spending approximately 85% of the workday using a PC. Minimal Lifting required. May have the option to work from home if deadlines are met continuously.

Compensation

• $23.58 - $29.48 hourly
• Non - Exempt Grade 12 Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members.
• The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

Our Commitment to Connection and Belonging

• At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace.
• We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.
• Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.
• For more than 70 years, Blue Cross and Blue Shield of Kansas has built a reputation of trust.
• As we move forward in this new era of health care we want to continue that tradition. Whether a member needs Blue Cross to cover an annual check-up or give them peace of mind during a major medical crisis, we want our members to know they can trust BCBSKS to meet their needs.
• Our mission: Being the insurer Kansans trust with their health.

Our Commitment to Connection and Belonging

• At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace.
• We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.
• Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.