Credentialing Specialist

Credentialing Specialist

Apply now Job no : 495875

Recruiter : Allison Plummer

Hiring Manager : Karen Walsh

Salary Grade : I-4

Work type : Regular

Location : Omaha, Nebraska, Lincoln, Nebraska, Columbus, NE, Kearney, Nebraska, Norfolk, NE, North Platte, NE, Scottsbluff, Nebraska, Nebraska

Categories : Administration

Blue Cross and Blue Shield of Nebraska (BCBSNE) is more than just an insurance company; we exist to be there for people in the best and hardest moments of their lives.

Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it!

As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

BCBSNE is happy to offer four work designations for our Omaha area employees : 100% in-office, Hybrid options, and 100% remote.

If choosing to work remote, this role can be located in one of the following states : Colorado, Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas.

This position is responsible for processing credentialing data for new and current network practitioners through data collection and primary source verification requiring compliance with URAC Standards, regulatory accreditation standards, Nebraska State statutes, HIPPA regulations and policies / procedures for presentation to the Credentialing Committee.

Responsible for the maintenance of the credentialing database, coordination with vendor system and provider files to meet credentialing requirements and deadlines.

What you'll do :

• Contact primary sources to verify credentialing and or re-credentialing information.
• Monitor and document timely receipt of information received.
• Generate weekly practitioner list and roster practitioners on CAQH as designated by the credentialing cycle within 36 months for re-credentialing applications and weekly for initial applications.
• Track submission of all documents required to begin the credentialing process for presentation to the Credentialing Committee by the month and year due.
• Evaluate credentialing and re-credentialing information against the URAC Credentialing Criteria for each practitioner type.
• Update and maintain practitioner applications, documents, database, and credentialing files in an organized and timely manner to facilitate easy retrieval of information, meet credentialing guidelines, and for credentialing reporting purposes.

To be considered for this position, you must have :

• High School Diploma or equivalent.
• Medical Terminology coursework and / or knowledge.

The strongest candidates for this position will also possess :

• Credentialing experience.
30+ days ago