Credentialing Specialist

Davita Inc.; South Carolina; Remote; USD 45,000 - 65,000; Full time

Job summary

A leading healthcare company is seeking a Credentialing Specialist to oversee the credentialing process for providers. In this full-time remote role, responsibilities include initial and re-credentialing of practitioners, database maintenance, and communication with network staff. Ideal candidates will have an Associate's degree and minimum two years of experience in the healthcare or insurance industry.

Benefits

Subsidized health plans

Dental and vision coverage

401k retirement savings plan with company match

Life Insurance

Paid Time Off (PTO)

Education Assistance

National discounts to entertainment venues

Qualifications

• Associate's degree required.
• 2 years in healthcare or insurance industry required.
• 2 years related job experience required.

Responsibilities

• Completes credentialing and re-credentialing of healthcare providers.
• Maintains and verifies accuracy of the credentialing database.
• Communicates with providers and internal teams on urgent matters.

Skills

Good judgment skills

Effective organizational skills

Customer service skills

Demonstrated verbal communication skills

Demonstrated written communication skills

Ability to handle confidential information

Education

Associate's degree

Tools

Microsoft Office

Job description

Internal Reference Number: R1045223
Summary We are currently hiring for a Credentialing Specialist to join BlueCross BlueShield of South Carolina. In this role as a Credentialing Specialist, you will be 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

Location

This position is full-time (40 hours/week) Monday-Friday from 8:00am - 5:00pm and will be fully remote.

What You'll 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.

To Qualify for This Position, You'll Need the Following:

• Required Education: Associate's

• Degree Equivalency: 2 years job related work experience.

• Required Work Experience: 2 years experience in the healthcare or insurance industry.

• Required Skills and Abilities: Good judgment skills. Effective organizational, 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.

• Required Software and Tools: Microsoft Office.

Our Comprehensive Benefits Package Includes the Following:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What To Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilitiesand protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email [e-mail] call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

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