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Operations Specialist, Associate
1 month ago
Your Role The Credentialing Operations team manages the oversight of all credentialing functions related to transactional processing, quality assurance and regulatory compliance. The Operations Specialist, Associate will report to the Credentialing Senior Manager. In this role you will lead as a subject matter expert in all relevant credentialing processes and procedures. Your Work In this role, you will: Act as subject matter expert and review operational workflows, identifying problems and acting as a SME to inform improvements, modifications, and enhancements Responsible for audit file building and 1st and 2nd pass peer review for regulatory/accrediting audit surveys Review systems and applications and recommend system edits/changes as needed Notify appropriate department mangers about issues and problems in operational workflow requiring immediate attention Stay current with knowledge of policies and procedures and NCQA, DHCS, DMHC and all other accrediting and regulatory credentialing and recredentialing standards Responsible for oversight of inventory management and ensuring compliance and audit readiness for professional practitioners and Health Delivery Organizations/Facilities Audit initial credentialing and recredentialing files according to established policies and procedures Coordinate and communicate quality and credentialing insights and issues with third-party support vendors Input accurate audit results into shared drive and relevant credentialing databases Identify areas of opportunities for process improvements to increase overall department quality output Maintain a high level of productivity and efficient when completing the audit process Your Knowledge and Experience Requires a bachelor’s degree or equivalent experience 0-2 years of prior relevant experience Required experience in a production or inventory driven environment with a focus on operations, state and federal regulations, industry standards and/or quality concepts Knowledge of credentialing requirements, process, and procedure by health plan preferred Desired analytical skills and experience identifying and resolving workflow and system problems Required written, verbal and interpersonal communication skills to present clear, concise and accurate information Pay Range: The pay range for this role is: $ 26.20 to $ 36.68 for California. Note: Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles. #LI-CP3
