Credentialing Assistant (AZ Remote)

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

PURPOSE OF THE JOB

The Credentialing Assistant facilitates the intake, data entry, and finalization of Credentialing requests.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

Required Work Experience

1 year of administrative experience

Required Education

High-School Diploma or GED in general field of study

Required Licenses

N/A

Required Certifications

N/A

PREFERRED QUALIFICATIONS

1. Preferred Work Experience

1 year of administrative experience, preferably within a credentialing/recredentialing environment and knowledge

national accreditation or regulatory criteria.

2. Preferred Education

Associates degree in a related field

3. Preferred Licenses

N/A

4. Preferred Certifications

N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

Intake, data enter, and scrub initial credentialing requests

Import CAQH, CVO, and delegated entity txt files into the eVIPs application

Oversee and triage incoming department emails

Monitor workflows in the eVIPs application assign files to Credentialing Coordinators as applicable

Provide status updates and notification of credentialing completion to internal departments

Clearly communicate credentialing rejections to Network Services staff

Submit credentialing files to the Credentials Verification Organization (CVO). Monitor credentialing files through processing with the CVO and ensure timely delivery to Credentialing Coordinators

Manage and import of daily receipt of Credentialing Data Transmission (CDT) files from CVO into eVIPs application

Escalate any issues identified in relation to work in progress (WIP) or credentialing files received by CVO to department leadership

Ensure providers CAQH applications are current, and all required documents are present in order to begin credentialing process with CVO

Coordinate with Network Services, providers, or other sources as necessary on follow-up items needed to complete the credentialing process

Maintain credentialing status within the eVIPs application. Update credentialing approval dates. Generate welcome letters and recredentialing approval letters and distribute to providers

Maintain ongoing participating in cross-training activities

Actively engage in addressing special projects as they arise

Provide recommendations and feedback regarding development of process improvements and/or standardization practices

Perform all other duties as assigned

The position 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

COMPETENCIES

REQUIRED COMPETENCIES

1. Required Job Skills

Familiarity with Microsoft Office software (Outlook, Word, Access, Excel, PowerPoint)

Ability to analyze and evaluate data and other provider related problems in order to develop alternative solutions for a positive outcome

Ability to multi-task and prioritize workload, manage multiple priorities, and pay meticulous attention to detail

Excellent organizational skills

Strong verbal and written communication skills

Maintains information in a confidential manner according to policy

2. Required Professional Competencies

Outstanding interpersonal skills, able to quickly establish a trusting rapport with individuals at all levels

3. Required Leadership Experience and Competencies

N/A

PREFERRED COMPETENCIES

1. Preferred Job Skills

Familiarity with credentialing database software

Thorough understanding of managed care credentialing

2. Preferred Professional Competencies

N/A

3. Preferred Leadership Experience and Competencies

N/A

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.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.