Credentialing Coordinator - (Remote in Arizona)Blue Cross Blue Shield of Arizona • Phoenix, Arizona, United States
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Credentialing Coordinator - (Remote in Arizona)
Blue Cross Blue Shield of Arizona
- Phoenix, Arizona, United States
- Phoenix, Arizona, United States
About
Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
Hybrid Individual Contributors: must reside in AZ, unless otherwise cited, required to be onsite at least once per week
Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited, required to be onsite at least once per month
Onsite: daily onsite requirement based on the essential functions of the job
Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one‑on‑ones, training, and team building
Please note that onsite requirements may change in the future based on business need and job responsibilities. Employees should expect onsite requirements, at a minimum, of once per week.
This position is remote within the state of AZ only. This remote work opportunity requires residency in Arizona and work to be performed within the State of Arizona.
Purpose of the Job The Credentialing Coordinator facilitates the accurate and efficient Credentialing and Recredentialing of Medicaid Business Segment providers in alignment with State, Federal, and NCQA standards.
Required Qualifications Work Experience
2 years of experience in a healthcare field
2 years of experience in provider credentialing
Education
High‑School Diploma or GED in general field of study
Licenses
N/A
Certifications
N/A
Preferred Qualifications Work Experience
2 years of experience in a healthcare field, preferably within a credentialing/recredentialing environment and knowledge of national accreditation and/or regulatory standards
Education
Associate's Degree in general field of study
Licenses
N/A
Certifications
Certified Provider Credentialing Specialist (CPCS)
Essential Job Functions and Responsibilities
Ensure timely and accurate processing of credentialing and recredentialing for both individual practitioners and organizations
Coordinate Credentialing Committee meeting, including preparing the agenda and documenting meeting minutes
Identify and communicate agenda items for Credentialing Committee to immediate leader
Facilitate prompt coordination with the Credentialing Verification Organization (CVO) and monitor Work in Progress file
Promptly address incoming files for processing
Review and maintain all applications for accuracy and completeness
Accurately and efficiently data enter primary source verification data into the credentialing database
Input credentialing decisions and dates into the credentialing database
Generate and mail approval letters to participating providers
Identify missing or erroneous information from the provider's application, and communicate with the provider to obtain
Coordinate with Network Services and/or other internal departments on follow‑up items needed to complete the credentialing process
Communicate with Network Services and/or other internal departments regarding status of provider and organizational credentialing
Maintain ongoing participation in cross‑training activities
Provide recommendations and feedback regarding process improvements and/or standardization practices
Actively participate in staff meetings, team huddles, and one‑on‑one meetings
Engage in team building activities
Perform all other duties as assigned
The position has an onsite expectation of 0 days per week and requires a full‑time work schedule. Full‑time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements
Required Competencies Job Skills
Verbal and written communication skills
Maintains confidentiality according to policy
Effectively communicate with internal and external customers via telephone and email
Accurately receive information through oral communication
Accurately review data and figures both in hard copy and electronic formats
Accurately sort through data and think through issues in a time‑pressured environment
Accurately learn and retain new information, knowledge, and skills
Efficiently manage multiple tasks, with varying degrees of priority, at the same time
Professional Competencies
Ability to think critically
Strong attention to detail
Excellent organizational skills
Outstanding interpersonal skills, ability to establish a trusting rapport with individuals at all levels
Maintain a calm and collected presence while addressing the concerns from an internal and external customer
Preferred Competencies Job Skills
Thorough understanding of managed care principles and physician practice operations, with an understanding of health plan credentialing preferred
Our Commitment AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
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Languages
- English
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