Principal Provider Credentialing & Eligibility Analyst @ Blue Cross and Blue Shield of Minnesota | Jobright.ai
JOBSarrow
RecommendedLiked
0
Applied
0
External
0
Principal Provider Credentialing & Eligibility Analyst jobs in Eagan, MN
Be an early applicantLess than 25 applicants
company-logo

Blue Cross and Blue Shield of Minnesota · 10 hours ago

Principal Provider Credentialing & Eligibility Analyst

ftfMaximize your interview chances
Insurance
check
Comp. & Benefits
badNo H1Bnote

Insider Connection @Blue Cross and Blue Shield of Minnesota

Discover valuable connections within the company who might provide insights and potential referrals.
Get 3x more responses when you reach out via email instead of LinkedIn.

Responsibilities

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.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Credentialing StandardsMicrosoft WordMicrosoft ExcelMicrosoft AccessCPCS certification

Required

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

Preferred

Bachelor's degree.
CPCS certification.

Benefits

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

Company

Blue Cross and Blue Shield of Minnesota

company-logo
About Blue Cross Blue Cross and Blue Shield of Minnesota is a taxable, nonprofit organization with a mission to make a healthy difference in people’s lives.

Funding

Current Stage
Late Stage

Leadership Team

leader-logo
Carrie S. Lawrence
Executive Administrator to the President & CEO and Chief of Staff
linkedin
leader-logo
Patsy Riley
Chief Goverment Officer and Senior Vice President and CEO, ClearStone Solutions
linkedin
Company data provided by crunchbase
logo

Orion

Your AI Copilot