Credentialing Processor

Ready to help us transform healthcare? Bring your true colors to blue. 

What we need:

The Credentialing Processor is primarily accountable for entering and validating information supplied by providers, provider organizations, and internal BCBSMA associates in support of the credentialing, directory and verification of provider update requests. The position is primarily responsible for ensuring that the credentialed providers meet all appropriate state and federal regulations, accreditation standards and BCBSMA Credentials & Peer Review Committee policies, and other governing entries prior to updating data.

This position is eligible for the eWorker persona but candidates must reside in MA.

Your Day to Day:

• Review, validate and verify data on recredentialing applications and Ancillary initial applications using a variety of documentation and system resources including but not limited to: Cactus, CAQH, CVO, ProviderHub, MyPal, and NASCO.
• Enter minimum credentialing data elements into the credentialing system to start the initial credentialing process.
• Review and verify data elements received on credentialing monitoring reports using a variety of documentation and system resources including but not limited to: Cactus, CAQH, CVO, ProviderHub, MyPal, and NASCO.
• Research and contact providers that have not responded to recredentialing applications.
• Periodically respond to both internal and external inquiries about credentialing activity.
• Identify documentation, system, and other discrepancies and alert management of any discrepancies.
• Coordinate with leaders and other team members to respond to priority requests and escalated provider issues as well as consistently achieve turnaround times and performance goals for quality and productivity.
• Proactively share information with other team members, and work in collaboration towards all departmental, divisional and corporate goals.
• Monitor faxes to the team.
• Enter veteran administration files into the credentialing system.
• Process and research task requests to updated credentialing data received from Provider Operations/Enrollment according to pre-established policies, workflows and guidelines in a timely and accurate manner. 
• Research credentialing projects when received.
• Verify data accuracy through supporting databases and websites including licensing boards, specialty certification boards, accreditation bureaus, sanction tracking websites and databases, etc.

We’re Looking for:

• Know and understand the importance of confidentiality within the credentialing environment.
• Demonstrate customer focus and service orientation.
• Possess strong research skills and attention to detail.
• Accountable for achieving personal and team goals and improving BCBSMA performance.
• Exhibit proven ability to navigate in multiple systems, including Windows based and Web based environments.
• Excellent organizational skills and the ability to work in a team and independently.
• Self-motivated, take the initiative and demonstrate the ability to work effectively in a fast-paced environment.
• Demonstrate flexibility and the ability to handle fast turnaround times and high volumes as needed.
• Possess personal commitment to high quality performance through integrity, accountability, compassion and teamwork.
• Proficiency in Microsoft Office Suite.
• Knowledge of BCBSMA data systems is desirable but not required.

What You Bring:

• HS diploma or equivalent, associate or bachelor’s degree preferred.
• One year of work experience in credentialing or an enrollment environment preferred.

#LI-Remote

Minimum Education Requirements:

High school degree or equivalent required unless otherwise noted above

Location

Hingham

Time Type

Full time

Hourly Range: $24.55 - $30.01

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting.  We may ultimately pay more or less than the posted range, and the range may be modified in the future.  An employee’s pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligi