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South Carolina’s largest and oldest health insurance company
Credentialing Manager
Location
South Carolina
Posted
10 days ago
Salary
0
Seniority
Senior
Job Description
Credentialing Manager
BlueCross BlueShield of South Carolina
• Manages day-to-day operations of credentialing area to include delegated credentialing activities. • Develops/implements credentialing policies/procedures/evaluation tools. • Evaluates/monitors/ensures compliance with National Committee of Quality Assurance (NCQA) and other regulatory standards/external review bodies. • Conducts on-site audits and inspections of delegated entities/provider files. • Communicates with/responds to internal and external representatives regarding data, delegation agreements, facility credentialing, and sanction issues. • Works with other departments to address/resolve credentialing issues. • Promotes efficiency through planning, problem solving, and application of industry standards. • Maintains accurate/current/efficient databases. • Coordinates/manages all activities and follows-up for credentialing committee. • Presents physicians/practitioners/providers with quality issues to committee for review. • Selects/trains/develops/guides staff and ensures excellent customer service is given to employees/customers/management, etc. • Monitors department performance and productivity. • Performs quality control functions for work performed. • Makes recommendations on process improvements and identifies training needs for staff.
Job Requirements
- Bachelor's in a job-related field
- 5 years healthcare experience to include healthcare program management, provider network, contracting or credentialing, managed care, medical education training, or physician office management; 2 of the 5 years must have been in a supervisory role or equivalent military experience in grade E4 or above.
- Knowledge/understanding of NCQA and JCAHO credentialing standards, credentialing/recredentialing process for healthcare practitioners and ancillary/institutional providers.
- Knowledge of medical terminology.
- Ability to work independently, prioritize effectively, make sound decisions.
- Good judgment skills.
- Demonstrated customer service, organizational, and presentation skills.
- Demonstrated verbal and written communication skills.
- Analytical or critical thinking skills.
- Ability to direct, motivate, and assess performance of others.
Benefits
- Subsidized health plans
- Dental and vision coverage
- 401k retirement savings plan with company match
- Life Insurance
- Paid Time Off (PTO)
- On-site cafeterias and fitness centers in major locations
- Education Assistance
- Service Recognition
- National discounts to movies, theaters, zoos, theme parks and more
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