Credentials Coordinator

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

Process practitioner and organizational provider applications for credentialing based on State and Federal regulations and NCQA accreditation standards.

• Responsible for the processing of practitioner and organization/facility provider applications for credentialing and recredentialing; requesting primary source documentation, processing documentation requirements, verifying information received, updating information in the system of record, evaluating over all case categorization and reporting findings to the Medical Director and Enterprise Credentialing Committee.
• Resolve inquiries related to credentialing file disposition.
• Provide credentialing status information for group administrators, physicians and their staff, Provider Services, Customer Service and Network Development Inquiries.
• May be designated by the leader to attend Credentials Committee meetings and conduct internal meetings and participate in auditing processes.
• Assist with special projects and job aids as needed.

Qualifications

• Associate degree preferred.
• Two (2) to five (5) years of work experience in provider enrollment, contracting, medical practice or hospital business office role and/or credentialing related field required.
• Knowledge of related state/federal regulations, NCQA, DIFS, MDHHS and CMS standards for credentialing required.
• Knowledge of CAQH required.
• Excellent organizational skills with attention to detail required.
• Excellent verbal and written communication skills required.
• Ability to handle and prioritize multiple case files and timelines required.
• Ability to work effectively independently or in a team environment required.
• Intermediate knowledge of Microsoft Word, Excel, Access, PowerPoint, and internet use required.
• Excellent interpersonal skills and the ability to interact with internal/external customers.