Principal Provider Credentialing

4 weeks ago

Eagan, United States Blue Cross and Blue Shield of Minnesota Full time $64,800 - $110,200
About Blue Cross

Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us.

How Is This Role Important to Our Work?

This self-motivated individual is responsible for working directly with our Medical Directors and managing and coordinating the medical professional committees, who review complex practitioner and provider credentialing and eligibility issues. The principle analyst prepares the highly sensitive, individual case work for these committees involving researching and coordinating complex practitioner and provider credentialing and eligibility issues to assure that practitioners and providers comply with Federal, State, BCBSA and BCBSMN accreditation and audit requirements.

A Day In The Life

  • Manage, maintain and publish Provider Credentialing Manual while adhering to all NCQA or other regulatory guidelines.
  • Understand and Monitor NCQA regulatory accreditation requirements for Credentialing Standards.
  • Take ownership for incorporating new and existing regulatory, accreditation or contractual requirements in all provider correspondence. (This includes policy writing, procedure documentation and provider letters).
  • Perform high level investigation and preparation of provider case summaries, for presentation at Credentialing Committee meetings.
  • Oversee the management of all cases where the Credentialing Committee has required a modified credentialing cycle.
  • Collaborate with international and federal government agencies, medical boards and other sources.
  • Reviews and determines next steps on provider cases that have been identified as deficient in the ongoing monitoring process.
  • This includes analyzing, developing, documentation and presenting special case issues to the Credentialing Committee.
  • Acts as Subject Matter Expert for internal and external customers regarding practitioner compliance issues.
  • Works directly with the internal and external practitioners to manage all aspects in the preparation and facilitation of the Credentialing and Appeal Committees meetings.
  • Oversees the Credentialing Analyst Sr and the work assigned to them.
  • Participates in other assigned projects and internal/external workgroups.

Required Skills And Experiences

  • 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
  • Ability to work independently and demonstrate advanced problem-solving skills.
  • Ability to apply expertise and knowledge of national and state credentialing standards, internal credentialing policies, practitioner participation requirements, data privacy laws and provider agreements.
  • Requires strong communication skills in both verbal and written forms.
  • Ability to apply advanced knowledge of computer and software applications, including Microsoft Word, Excel, Access

Nice To Have

  • Bachelor's degree.
  • CPCS certification.

Compensation And Benefits

Pay Range: $64,800.00 - $87,500.00 - $110,200.00 Annual

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We Offer a Comprehensive Benefits Package Which May Include

  • Medical, dental, and vision insurance
  • Life insurance
  • 401k
  • Paid Time Off (PTO)
  • Volunteer Paid Time Off (VPTO)
  • And more

To discover more about what we have to offer, please review our benefits page.

Make A Difference

Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.

Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.

All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.

Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.

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