Credentialing Coordinator - (Remote in Arizona)

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.AZ Blue offersa 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. At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements: 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 within this posting, 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 within this posting, 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. Most employees should expect onsite requirements and at a minimum of once per week. This position is remote within the state of AZ only. This remote work opportunity requires residency, 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 Required Work Experience 2 years of experience in a healthcare field 2 years of experience in provider credentialing Required Education High-School Diploma or GED in general field of study Required Licenses N/A Required Certifications N/A Preferred Qualifications Preferred 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 Preferred Education Associate's Degree in general field of study Preferred Licenses N/A Preferred 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 Required 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 Required 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 Preferred Job Skills Thorough understanding of managed care principles and physician practice operations, with an understanding of health plan credentialing preferred Preferred Professional Competencies N/A 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. #J-18808-Ljbffr Blue Cross Blue Shield of Arizona