Credentialing Technician @ Blue Cross Blue Shield of Arizona

Administrative & Executive Assistance (1)

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.

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

Responsible for organization and performance of credentialing/recredentialing activities of BCBSAZ and TriWest Healthcare Alliance providers. This includes primary source verification, review of data, data input, assembly of required documentation, generation of reports, filing, communication with physicians and other health care providers, and preparation of information for the Credentials Committee .

Qualifications

REQUIRED QUALIFICATIONS

Required Work Experience

5 year(s) of experience in business office field (Applies to All Levels)
1 year(s) of experience in credentialing in a managed care field (Applies to Level 2)
2 year(s) of experience in credentialing in a managed care or hospital field (Applies to Level 3)

Required Education

High-School Diploma or GED in general field of study (Applies to All Levels)

Required Licenses

Required Certifications

PREFERRED QUALIFICATIONS

Preferred Work Experience

Preferred Education

Associate's Degree in general field of study (Applies to Levels 2 - 3)

Preferred Licenses

Preferred Certifications

Certified Professional in Medical Services Management (CPCSM) (Applies to Levels 2 - 3)
- Certified Professional Credentialing Specialist (CPCS) (Applies to Levels 2 - 3)

ESSENTIAL job functions AND RESPONSIBILITIES

Level 1

Perform follow up process for applications that have not been returned as part of the recredentialing process.
Identify and obtain missing information from providers in order to satisfy the requirements of the credentialing policies and procedures.
Perform primary source verifications of such items as licensure and education for individual providers per written Credentialing policies and procedures.
Review provider credential files against defined criteria to determine whether providers meet BCBSAZ’s credentialing requirements for both initial and recredentialing files. This includes both professional and facility credentialing files.
Maintain accuracy and completeness of credentialing files and ensure consistency with URAC, TriWest, and BCBSAZ credential standards.
Organize and prioritize activities related to the delegated credential function as required by TriWest Healthcare Alliance delegation agreement.
Prepare files for Credentials Committee meetings including documentation of exception conditions.
Correspond effectively with providers, BCBSAZ, TriWest and other outside agencies, both verbally and in writing, to assemble and communicate credentialing/recredentialing information.
Perform computer data entry and generation of reports.
Maintain knowledge of provider files, and applicable credentialing and/or contracting databases.
Participate in continuing education to maintain certification, if applicable; attend courses offered by BCBSAZ's Corporate Training and Development and the Health Services Division; participate in computer-related educational offerings as related to position function.
Maintain standards of ethical practice and confidentiality; Apply appropriate security and privacy measures to all tasks .

Level 2

Perform quality control (QC) activities on completed files following QC Policy and utilizing the QC tool for both professional and facility files.
Perform ongoing monitoring per policy to meet URAC standards.
Develop and maintain desktop procedures for all credentialing / recredentialing activities as directed.
Compile and validate reports for Credentials Committee meetings.

Level 3

Perform audits of delegated credentialing functions to ensure that all URAC and BCBSAZ specific standards are met.
Develop and maintain desk level procedures for all credentialing and recredentialing activities as directed.

ALL Levels

Each progressive level includes the ability to perform the essential functions of any lower levels.
The position has an onsite expectation of 5 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.
Perform all other duties as assigned .

competencies

REQUIRED COMPETENCIES

Required Job Skills

Intermediate PC proficiency (Applies to All Levels)
Intermediate skill using office equipment, including copiers, fax machines, scanners and telephones (All Levels)
Basic skill in word processing, spreadsheet and database software (Applies to All Levels)

Required Professional Competencies

Maintain confidentiality and privacy
Ability to set priorities
Analytical knowledge necessary to generate reports based on available data and then make decisions based on reported data
Capable of investigative and analytical research
Practice interpersonal and active listening to achieve high customer satisfaction and departmental communication standards
Establish and maintain working relationships in a collaborative team environment

Required Leadership Experience and Competencies

PREFERRED COMPETENCIES

Preferred Job Skills

Intermediate skill in word processing, spreadsheet and database software (Applies to All Levels)

Preferred Professional Competencies

Preferred Leadership Experience and Competencies

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.

Credentialing Technician

Credentialing

Blue Cross Blue Shield of Arizona

Purpose of the job

Qualifications

ESSENTIAL job functions AND RESPONSIBILITIES

competencies

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