Credentialing Operations Specialist

Blue Cross Blue Shield of Michigan; Detroit (MI); On-site; USD 52,000 - 65,000; Full time

Job summary

Blue Cross Blue Shield of Michigan is seeking a credentialing professional to process practitioner and organizational provider applications in accordance with State and Federal regulations and NCQA standards.

The role involves documenting primary sources, updating records, and reporting findings to leadership. You will resolve file disposition inquiries, support group administrators, physicians and staff, and participate in committee meetings and audits.

Qualifications

• Two to five years of work experience in provider enrollment, contracting, medical practice or hospital business office role and/or credentialing related field required.
• Knowledge of state/federal regulations, NCQA, DIFS, MDHHS and CMS standards for credentialing required.
• Knowledge of CAQH required.
• Excellent organizational, verbal and written communication skills required.
• Ability to handle and prioritize multiple case files and timelines; work independently or in a team.

Responsibilities

• Process practitioner and organization/facility provider applications for credentialing and recredentialing, requesting documentation and updating systems.
• Verify information received and evaluate case categorization; report findings to Medical Director and Credentialing Committee.
• Resolve inquiries related to credentialing file disposition.
• Provide credentialing status information for group administrators, physicians and staff, Provider Services and Network Development.
• Attend Credentials Committee meetings and assist with audits and special projects.

Skills

Organizational skills

Communication skills

Multitasking

Independence/Teamwork

Interpersonal skills

Education

Associate degree

Tools

Microsoft Word

Excel

Access

PowerPoint

Internet use

Job description

Blue Cross Blue Shield of Michigan is seeking a credentialing professional to process practitioner and organizational provider applications in accordance with State and Federal regulations and NCQA standards.

The role involves documenting primary sources, updating records, and reporting findings to leadership. You will resolve file disposition inquiries, support group administrators, physicians and staff, and participate in committee meetings and audits.