Credentialing Specialist: Streamline Provider Enrollment

Blue Cross Blue Shield of Michigan; Detroit (MI); On-site; USD 55,000 - 75,000; Full time

Job summary

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

The role involves requesting primary source documents, verifying data, updating the system of record, and reporting findings to the Medical Director and Enterprise Credentialing Committee, while also handling inquiries and supporting committee meetings.

Qualifications

• Associate degree preferred.
• 2–5 years in provider enrollment, contracting, medical practice or credentialing.
• Knowledge of state/federal regulations, NCQA, DIFS, MDHHS and CMS standards.
• Knowledge of CAQH required.
• Excellent organizational skills with attention to detail.
• Excellent verbal and written communication skills.
• Ability to handle and prioritize multiple case files and timelines.
• Ability to work independently or in a team environment.
• Intermediate knowledge of Word, Excel, Access, PowerPoint and internet use.
• Excellent interpersonal skills and interaction with customers.

Responsibilities

• Process practitioner and organization/facility credentialing and recredentialing applications.
• Request primary source documentation, verify information, and update systems.
• Evaluate case categorization and report findings to Medical Director and Credentialing Committee.
• Resolve inquiries related to credentialing file disposition.
• Provide credentialing status information to group admins, physicians and staff.
• Attend Credentials Committee meetings and participate in audits when designated.
• Assist with special projects and job aids as needed.

Skills

Organizational skills

Verbal communication

Written communication

Attention to detail

Multitasking

Teamwork

Independence

Interpersonal skills

Time management

Education

Associate degree

Tools

Microsoft Word

Microsoft Excel

Microsoft Access

Microsoft PowerPoint

Internet use

Job description

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

The role involves requesting primary source documents, verifying data, updating the system of record, and reporting findings to the Medical Director and Enterprise Credentialing Committee, while also handling inquiries and supporting committee meetings.