Specialist, Credentialing - Request #37634072

WillHire; Columbia, Northern (SC, KY); Hybrid; USD 22,000 - 28,000; Full time

Benefits offered by this job

Medical

Dental

Vision

401K

Job summary

BlueCross BlueShield of South Carolina is seeking a Specialist, Credentialing to manage initial and re-credentialing for providers across multiple business lines. The role requires strong organization, database management, and communication with internal teams and providers.

The position is onsite in Columbia, SC with a 2-3 week training period and a contract-to-hire arrangement. Local candidates with 2 years in healthcare or insurance are preferred.

Qualifications

• Associate's Degree or two years of related work experience.
• 2 years of experience in the healthcare or insurance industry.
• Familiarity with credentialing processes and databases.

Responsibilities

• Complete initial credentialing and re-credentialing for providers across lines of business.
• Maintain credentialing databases and ensure data accuracy and currency.
• Generate credentialing reports and assist related departments as needed.
• Communicate with providers, staff, and management on credentialing matters.
• Attend credentialing committee meetings and participate in program improvements.

Skills

Microsoft Office skills

Research experience

High level of computer skills

Highly organized

Experience with re-credentialing

Communicates with impact

Manages database files for reporting

Understands credentialing provider lif

Education

Associate's Degree

Tools

Credentialing database

Job description

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we’re stronger than ever. Our A.M. Best rating is A+ (Superior) — making us the only health insurance company in South Carolina with that rating. We’re the largest insurance company in South Carolina …and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Job Title: Specialist, Credentialing

Position Details:

• CONTRACT TO HIRE
• SCHEDULE : M-F. 8:00-4:30.
• ONSITE or VIDEO INTERVIEWS? Video
• TRAINING: 2-3 week training.
• ONSITE, HYBRID, or REMOTE POSITION? Onsite
• DO THE CANDIDATES NEED TO BE LOCAL? Yes

2-4 PREFERRED/NICE TO HAVE skill sets/qualities:

• Microsoft Office skills
• Research experience
• High level of computer skills
• Highly organized
• Experience with re-credentialing

Duties:

• 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.
• 35% 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.
• 35% 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.
• 20% 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.
• 10% 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. Performs quality control checks/reviews/oversight of delegated entities including traveling as required to perform credentialing delegation audits. Present delegated audit findings to credentialing committee.

Skills and Abilities:

• Communicates with impact
• Manages database files for reporting
• Understands credentialing provider lifecycle

Required Education: Associate's Degree or Two years of related work experience

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

Pay Transparency:

• This is the pay range that Magnit reasonably expects to pay someone for this position is $16.00/hour - $20.00/hour W-2.
• Benefits: Medical, Dental, Vision, 401K (provided minimum eligibility hours are met).

BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more.

Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson.If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty.