Blue Cross and Blue Shield of Minnesota · 5 hours ago
Principal Provider Credentialing & Eligibility Analyst
Eagan, MN
Full-time
Remote
Mid, Senior Level
$65K/yr - $110K/yr
5+ years exp
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No H1B
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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
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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
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.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Carrie S. Lawrence
Executive Administrator to the President & CEO and Chief of Staff
Patsy Riley
Chief Goverment Officer and Senior Vice President and CEO, ClearStone Solutions
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