Accreditation Standards, Corporate Compliance, Dental Insurance, Educational Accreditation, Federal Compliance Regulations, Fitness, Health Plan, High School Diploma, Incentive Programs, Medical Terminology, Network Integration, Problem Solving Skills, Regulatory Compliance, Reimbursement, Team Player, Time Management, Training Program, Training/Teaching, Vision Plan
Why Join Us?
- Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
- FamilyComes First: Total rewards package that promotes the idea of family first for all employees. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire
- Professional Growth Opportunities: Advance your career with ongoing training and development programs.
- Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility.
- Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community.
- Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected.
Benefits & Perks
- Base compensation is only one component of your competitive Total Rewards package
- Incentive pay program (EPIP)
- Health/Vision/Dental insurance
- 6 weeks paid parental leave for new mothers and fathers
- Fertility/Adoption assistance
- 2 weeks paid caregiver leave
- 401(k) plan matching up to 5%
- Tuition reimbursement
- Health & fitness benefits, discounts and resources
Job Summary
Responsible for the prompt, courteous, accurate, and timely handling of incoming telephone calls, emails, and written correspondence from professional providers, or their designees, covering all lines of business regarding their credentialing application. Serve as a resource for Provider Network Services, Reimbursement Records, and internal customers of provider records. Directly engage with providers and their designees regarding questions related to credentialing. Responsible for reviewing credentialing application against mandatory health plan accreditation elements to ensure accuracy and completeness prior to Corporate Credentialing Committee review for network enrollment and participation.
"This position is eligible to work hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment."
What you'll do
- Responsible for reviewing credentialing applications and preparing files for the Corporate Credentialing Committee. Involves, but not limited to, outreach to providers or their designees to obtain missing information and/or update expired CAQH application.
- Complete primary source verification including license, board certification, Medicare/Medicaid sanction activity (OIG), National Practitioner Data Bank, professional liability coverage, and accreditation status.
- Provides education and answers questions timely and accurately for providers or their designees regarding credentialing requirements.
- Responsible for adding providers to the CAQH Roster prior to providers 36-month recredentialing deadline.
- Complete credentialing system record entry, coordinate enrollment processing within operations division to complete network enrollment after credentialing completion.
- Monitors, records, and assigns incoming paper credentialing applications.
- Understand and interpret credentialing compliance rules and regulations and apply to credentialing applications and processing.
- All credentialing activities must be completed according to accreditation standards and be aligned with accreditation, corporate, and federal compliance requirements.
What you need
Knowledge/Skills/Abilities
- Responsible for preparing confidential documents and must maintain strict confidentiality.
- Independently determines best approach to solving problems.
- Ability to focus on details with the ability to rapidly switch tasks to complete diversified work items within prescribed deadlines.
- Must comply with Corporate Compliance Program to ensure proven network value and integrity.
- Must complete annual accreditation standards education/training on job functions that is included as part of the adopted and in place health plan accreditation. Must be able to follow required accreditation standards as required for essential job functions.
Education and Experience:- High school graduate or equivalent required with additional education in communications, human relations, or medical terminology.
- One year of operational ex
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Blue Cross Blue Shield of Kansas