Job Description

Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,800 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.

Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

Trains new employees in Credentialing Services, and conducts the ongoing training of existing employees on BCBSAZ, TriWest and URAC credentialing requirements for both individual and institutional credentialing; responsible for the development of training manuals and supporting documentation.

  • Responsible for the organization and performance of credentialing/recredentialing activities of Blue Cross and Blue Shield of Arizona (BCBSAZ) and TriWest Healthcare Alliance providers.  This includes primary source verification, review of data, data input, assembly of required documentation, generation of reports, filing, communication with physicians and other health care providers, and preparation of information for the Credentials Committee.

Qualifications

REQUIRED QUALIFICATIONS

Required Work Experience
  • 5 years of experience in business office with increasing responsibilities field
  • 3 years of experience in credentialing process in a managed care organization or hospital field

Required Education

  • High-School Diploma or GED in  general field of study

]

Required Licenses

  • N/A

Required Certifications

  • Certified Professional in Medical Services Management (CPMSM)  or Certified Professional Credentialing Specialist (CPCS )

PREFERRED QUALIFICATIONS

Preferred Work Experience
  • N/A
Preferred Education
  • Associate’s Degree in general field of study
Preferred Licenses
  • N/A
Preferred Certifications
  • N/A

ESSENTIAL job functions AND RESPONSIBILITIES

 

LEVEL 1:

  • Develop and maintain training manuals for individual and institutional credentialing processes.
  • Provide training to new credentialing employees on the BCBSAZ, URAC and TriWest credentialing requirements.
  • Monitor files of new employees to ensure compliance with the BCBSAZ, URAC and TriWest credentialing requirements.
  • Train all credentialing employees on new processes or use of new websites for credentialing verification purposes. 
  • Perform primary source verifications of such items as licensure and education for individual providers per written Credentialing policies and procedures.
  • Review provider credential files against defined criteria to determine whether providers meet BCBSAZ’s credentialing guidelines.
  • Maintain accuracy and completeness of credentialing files and ensure consistency with URAC, TriWest and BCBSAZ standards.
  • Prepare files for Credentials Committee meetings.
  • Correspond effectively with providers, BCBSAZ, TriWest and other outside agencies, both verbally and in writing, to assemble and communicate credential/recredential information.
  • Perform computer data entry and generation of reports.
  • Develop and maintain desktop procedures for all credentialing/recredentialing activities as well as training manuals as directed.
  • Compile, submit and maintain statistical workload reports for department analysis.
  • Along with the Credentialing Manager, is responsible for the quality management program for credentialing, including monitoring of the quality improvement projects.
  • Maintain thorough knowledge of provider files, and applicable credentialing and/or contracting databases.
  • Participate in continuing education to maintain certification, if applicable; attend courses offered by BCBSAZ’s Corporate Training and Development department and the Health Services Division; participate in computer-related educational offerings as related to position function.
  • Participate on internal committees as necessary to maintain a current general knowledge of the company products, goals and functions.
  • Maintain standards of ethical practice and confidentiality.
  • Apply appropriate security and privacy measures to all tasks.

  • The position requires a full-time work schedule.  Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
  • Perform all other duties as assigned .

LEVEL 2:

  • Must be proficient in all job functions in Level 1
  • Acts as the system administrator for the National Practitioner Databank (NPDB), including the Proactive Disclosure System (PDS), and for any other accounts necessary for primary source verification of credentials
  • Acts as a liaison between BCBSAZ and the Arizona Department of Health Services (AzDHS) for all research regarding licensure and facility types
  • Acts as a liaison between BCBSAZ and professional licensing boards for all changes in statutes and scope of practice questions

  • Acts as a liaison between BCBSAZ and AzDHS as well as professional licensing boards regarding mental health parity questions
  • Conducts extensive research when necessary to assist in the implementation of new license types or the changes of license types by either AzDHS or the professional licensing boards
  • The position requires a full-time work schedule.  Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
  • Perform all other duties as assigned

­­­­­­­­­­­­­­­­­­

REQUIRED COMPETENCIES

Required Job Skills

  • Intermediate PC proficiency
  • Intermediate skill in use of office equipment, including copiers, fax machines, scanners and telephones
  • Intermediate skill in word processing, spreadsheet and database software

Required Professional Competencies

  • Training of credentialing materials
  • Maintain confidentiality and privacy
  • Set priorities
  • Analytical knowledge necessary to generate reports based on available data and then make decisions based on reported data
  • Capable of investigative and analytical research
  • Practice interpersonal and active listening to achieve high customer satisfaction and departmental communication standards
  • Establish and maintain working relationships in a collaborative team environment

Required Leadership Experience and Competencies

  • Resource management skills

PREFERRED COMPETENCIES

Preferred Job Skills

  • N/A

Preferred Professional Competencies

  • Knowledge of URAC accreditation standards
  • Preferred Leadership Experience and Competencies
  • N/A

Our Commitment

BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank You

Thank you for your interest in Blue Cross Blue Shield of Arizona.  For more information on our company, see azblue.com.  If interested in this position, please apply.


Imagine doing life-changing work and helping more than one million Arizonans live healthier and longer lives. That’s the kind of satisfaction you’ll find when you work here. Our exceptional teams in Phoenix, Tucson, Chandler, and Flagstaff have been transforming healthcare for more than 80 years. Explore what's possible with a career at Blue Cross® BlueShield® of Arizona



Posted 21 Days Ago

Full time

R409

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

Apply Online