What are the responsibilities and job description for the Credentialing specialist position at Horizon Blue Cross Blue Shield of New Jersey?
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Job Summary :
Responsible for coordinating and maintaining all health care professional and facility demographic credentials including processing any associative additions changes and terminations.
Interacts with internal / external vendors and agencies to facilitate compliance with current credentialing standards.
Responsibilities :
Process all assigned credentialing, recredentialing, billing discrepancies, terminations, and any additional functions as requested by management timely and accurately.
Oversee credentialing and application process for network participants,, including compliance with all government, state, and organizational credentialing mandates.
Verifies that the required credentialing documentation on file meets credentialing mandates and timeframes prior to submission for approval.
Reviews / offers suggestions on corrections and follow-up while working with health care professionals to meet required credentialing / recredentialing criteria
Serves as primary contact for all credentialing verification with focus on ensuring timely and complete credentialing submissions leading to credentialing database accuracy.
Interacts with state agencies the National Committee for Quality Assurance (NCQA), or the Utilization Review Accreditation Commission (URAC) to stay current on licensing and credentialing requirements.
Responsible for the timely, accurate data entry of demographic information for all health care professionals and facilities within company’s proprietary database system.
Identifies and recommends potential process improvement opportunities to enhance the current
Disclaimer :
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification.
It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.
Education / Experience :
High School Diploma / GED required.
Requires a minimum of two years’ experience in health care with a concentration in provider credentialing / database maintenance.
Knowledge :
Requires in-depth knowledge of Windows based environments including MS Office Products and email application systems.
Prefer knowledge and familiarity with NCQA / URAC credentialing terminology and requirements.
Skills and Abilities :
Must possess strong math skills.
Attention to Detail
Organization and Time Management
Deadline Focused
Salary Range : $43,300 - $57,960
$43,300 - $57,960
This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to : education, experience, licensure, certifications, geographic location, and internal equity.
This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case.
Horizon also provides a comprehensive compensation and benefits package which includes :
Comprehensive health benefits (Medical / Dental / Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement
Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law.
Last updated : 2024-08-29
Salary : $43,300 - $57,960
