Credentialing Manager

Summary

We are currently hiring for a Credentialing Manager to join BlueCross BlueShield of South Carolina. In this role as a Credentialing Manager, you will be responsible for the management of all provider credentialing activities/credentialing program for commercial business, Medicare, Medicaid, and delegated credentialing for all BCBSSC lines of business. This position will also be responsible for designing and implementing process improvements to the credentialing process to include but not limited to system enhancements. Description Location This position is full-time (40 hours/week) Monday-Friday from 8:00am-5:00pm and will be remote. Our ideal candidate must reside within reasonable proximity to Columbia, SC as they may be required to report onsite occasionally for trainings, meetings, or other business needs. What You’ll Do: 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. To Qualify for This Position, You'll Need the Following: Required Education: Bachelor's in a job-related field Required Work Experience: 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 supervisory role or equivalent military experience in grade E4 or above. Required Skills and Abilities: 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. We Prefer That You Have the Following: Preferred Skills and Abilities: Must have a strong background in developing credentialing processes, system deployments, and workforce management. Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment. 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 What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will conduct interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email [email protected] or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information. If you don’t have an account with us and don’t see the dream job you are looking for, click on the link above to Join Our Talent Community by submitting your resume and contact information and we will reach out if we find a good fit. Welcome Here’s Your Smart Career Move Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we’re stronger than ever. Our A.M. Best rating is A+ (Superior) — making us the only health insurance company in South Carolina with that rating. We’re the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Veterans Welcome! BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty. 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