Credentialing Manager

About the role

We are currently hiring for a Credentialing Manager to join BlueCross BlueShield of South Carolina. In this role as a Credentialing Manager, you will be responsible for the management of all provider credentialing activities/credentialing program for commercial business, Medicare, Medicaid, and delegated credentialing for all BCBSSC lines of business. This position will also be responsible for designing and implementing process improvements to the credentialing process to include but not limited to system enhancements. Location This position is full-time (40 hours/week) Monday-Friday from 8:00am-5:00pm and will be remote. Our ideal candidate must reside within reasonable proximity to Columbia, SC as they may be required to report onsite occasionally for trainings, meetings, or other business needs.

Responsibilities

• Communicates with/responds to internal and external representatives regarding data, delegation agreements, facility credentialing, and sanction issues. Works with other departments to address/resolve credentialing issues.
• Promotes efficiency through planning, problem solving, and application of industry standards. Maintains accurate/current/efficient databases.
• Coordinates/manages all activities and follows-up for credentialing committee. Presents physicians/practitioners/providers with quality issues to committee for review.
• To Qualify for This Position, You'll Need the Following:
• Required Education: Bachelor's in a job-related field
• Required Skills and Abilities : Knowledge/understanding of NCQA and JCAHO credentialing standards, credentialing/recredentialing process for healthcare practitioners and ancillary/institutional providers.
• Knowledge of medical terminology.
• Ability to work independently, prioritize effectively, make sound decisions.
• Good judgment skills.
• Demonstrated customer service, organizational, and presentation skills.
• Demonstrated verbal and written communication skills.
• Analytical or critical thinking skills.
• Ability to direct, motivate, and assess performance of others.
• We Prefer That You Have the Following:
• Preferred Skills and Abilities: Must have a strong background in developing credentialing processes, system deployments, and workforce management.
• Our Comprehensive Benefits Package Includes the Following:
• We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment.
• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more
• What We Can Do for You:
• We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
• What To Expect Next:
• Equal Employment Opportunity Statement

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