Blue Cross and Blue Shield of Louisiana Provider Credentialing Specialist in Baton Rouge, Louisiana
We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.
Please note that effective Jan. 4, 2022, Blue Cross and Blue Shield of Louisiana implemented a policy requiring any employee who enters any of our offices or who interacts in person with anyone for company business purposes to be fully vaccinated for COVID 19, unless legally entitled to a reasonable accommodation related to religious or medical exemptions. At this time, that policy is suspended and vaccination is not required to enter our facilities. Please note this is subject to change at any point in time to ensure compliance with company policy or government mandates and certain client facing roles may have separate protocols.
Residency in or relocation to Louisiana is preferred for all positions.
Compiles appropriate information to make requested credentialing, contractual, and demographic updates and changes related to provider data in the systems of record in an accurate, complete and timely manner. Manages and sustains positive provider relationships. Sets up providers and networks in systems of record, assigns provider numbers and communicates with provider community. Facilitates accurate financial claims payment and provider directory processes. Represents BCBSLA to external provider communities and internal stakeholder groups.
NATURE AND SCOPE
This role does not manage people
This job reports to: Departmental Leadership
Necessary Contacts: In order to effectively fulfill this position, the incumbent must be in contact with: Network Operations, EDI, Network Development, Provider Services, Customer Service Units and other internal departments as needed; regulatory agencies, facility providers, practitioner providers, office managers, and provider licensing agencies.
High School Diploma or equivalent is required.
Prefer an Associate or Bachelor's degree in business or health related field.
2 years of credentialing, enrollment and billing, claims, and/or insurance operations experience are required.
Strongly prefer data entry and/or maintenance of claims processing systems and databases experience related to credentialing, provider enrollment or provider services.
Provider credentialing and/or operations experience strongly preferred.
Experience can run concurrently.
Skills and Abilities
Demonstrated knowledge of insurance services and operations.
Strong communication skills with internal and external stakeholders is required.
Ability to effectively communicate with provider community and credentialing representatives (e.g. licensing agencies, educational institutions, etc.) in a professional manner preferred.
Basic knowledge and understanding of the credentialing and provider enrollment process is preferred.
Facets, IPD, Provider Manager, and Cactus knowledge preferred.
Prior claims processing experience preferred.
Strong analytical skills/problem solving skills preferred.
Critical thinking/ability to question preferred.
Provider (customer) focused preferred.
Interpersonal skills/relationship building skills preferred.
Ability to multitask in a fast-paced production environment preferred.
Strong organizational skills/Time management preferred.
Takes accountability for work performed.
Prefer ability to work both individually and in a team environment with shared goals.
Ability to work under pressure to produce high quality work with defined turnaround goals preferred.
Ability to effectively adapt to change preferred.
Licenses and Certifications
- None Required
ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS
Accurately setups providers in provider systems of record to ensure appropriate claims payment in accordance with contractual language.
Compiles, analyzes, and verifies the required information for provider credentialing, enrollment, contracts, and maintenance for completeness and accuracy, and enter it into the systems of record.
Communicates, orally and in writing, directly with providers and/or external credentialing verification representatives to resolve questions and issues regarding updates and changes in the systems of record.
Researches, responds to, analyzes and resolves complex claims and/or provider credentialing issues related to provider setup and provider eligibility on a daily basis.
Creates resolution documents to address provider issues and increase provider satisfaction. Utilizes probing and problem solving methods to resolve all inquiries/requests. Identifies, understands and anticipates providers unexpressed needs and concerns.
Provides cross functional support and serves as subject matter resource or second tier resolution to internal and external provider teams (i.e., Contracting, Provider Relations, etc).
Manages timely responses to external provider inquiries and requests. Evaluates new service and/or provider credentialing requests from providers to determine appropriate actions for recording into the systems of record.
Recommend, and participate in process improvement opportunities for Network Management Operations.
Identify system problems, gaps or inconsistencies in workflows and/or processes. Recommend appropriate updates, alternatives and solutions.
Accountable for complying with all laws and regulations associated with duties and responsibilities.
Additional Accountabilities and Essential Functions
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions
Perform other job-related duties as assigned, within your scope of responsibilities.
Job duties are performed in a normal and clean office environment with normal noise levels.
Work is predominately done while standing or sitting.
The ability to comprehend, document, calculate, visualize, and analyze are required.
An Equal Opportunity Employer
All BCBSLA EMPLOYEES please apply through Workday Careers.
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In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.
Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.
Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.
JOB CATEGORY: Insurance