Credentialing Enrollment Specialist

Bcbsks; United States; Hybrid; USD 42,000 - 65,000; Full time

Benefits offered by this job

Health Insurance

Vision Insurance

Dental Insurance

Parental Leave

401(k) Matching

Tuition Reimbursement

Health & Fitness Benefits

Incentive Pay

Job summary

BCBSKS is seeking a Credentialing Specialist to manage incoming credentialing inquiries and prepare files for the Corporate Credentialing Committee. You will verify licenses, board certifications, and CAQH data, and coordinate enrollment and recredentialing timelines with internal teams.

You will liaise with providers and designees, ensure compliance with accreditation standards, and maintain confidential records.

Qualifications

• High school diploma or equivalent; relevant education preferred.
• Experience or training in credentialing processes is a plus.

Responsibilities

• Review credentialing applications and prepare files for Corporate Credentialing Committee.
• Verify licenses, board certifications, and CAQH data.
• Coordinate enrollment processing and recredentialing timelines.

Skills

Attention to detail

Confidentiality

Communication skills

Multitasking

Problem solving

Teamwork

Customer service

Education

High school diploma or equivalent

Additional education in communications/medical terminology

Tools

CAQH system

Enrollment systems

Microsoft Office

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 involv