Job Description

Provider Relations Credentialing Specialist Location Cheyenne, WY : Summary: The Provider Relations Credentialing Specialist is responsible for maintaining current credentials and licenses with Wyoming Providers in their field or specialty. The role incumbent is accountable for assisting in the contracting and credentialing of BCBSWY Providers, problem resolution, and relationship building; also responsible for further development and monitoring of electronic claims submission activity, maintenance of daily internal administrative functions and the provider database system. : JOB SUMMARY The Provider Relations Credentialing Specialist is responsible for maintaining current credentials and licenses with Wyoming Providers in their field or specialty. The role incumbent is accountable for assisting in the contracting and credentialing of BCBSWY Providers, problem resolution, and relationship building; also responsible for further development and monitoring of electronic claims submission activity, maintenance of daily internal administrative functions and the provider database system. ESSENTIAL DUTIES & RESPONSIBILITIES

• Responsible for initiating communication, credentialing and contracting correspondence with potential affiliated providers. This is a daily activity as information is received.
• Accurately processes initial credentialing and re-credentialing applications on a timely basis.
• Consistently and thoroughly screens practitioners' applications and supporting documentation to determine eligibility.
• Collects information from the National Practitioner Data Bank (NPDB), the applicant, and their malpractice insurer, and other relevant sources to support consistent and effective processing; retains and tracks captured information as may be necessary.
• Professionally responds to internal and external issues involving providers, initiating internal actions when necessary to resolve problems on a daily basis. Provides oral and written communications to providers.
• Accountable for the ongoing monitoring of Wyoming Providers credentials and licenses; partners with Human Resources as needed for their recordkeeping and compliance with URAC HR Standards regarding BCBSWY employed providers.
• Responsible for the Quality Control (QC) of data entered by Administrative Clerk and completed credentialing applications for accuracy.
• Assists in TriWest credentialing as may be assigned to support team accountability.
• Assists in the development and distribution of provider education including bulletins/notices, fee information and/or other similar type information, including development of the provider portal on
• Engages in process improvements such as the expansion of electronic claim transmission environment; also responsible for professionally responding to inquiries relating to electronic claims submission, including obtaining TPA agreement with providers who submit health information electronically according to HIPAA guidelines.
• Accurately enters correspondence control information as may be required; regularly updates provider files, engages in research as requested/assigned and routinely provides needed/assigned inter-office reporting.
• This essential duties listing is not all inclusive, but representative. Other duties may be assigned.
NON-ESSENTIAL DUTIES & RESPONSIBILITIES
• May be requested to support other Provider Relations team members as backup (cross-trained as needed) and serve as a training resource cross-departmentally when needed.
• Assists Provider Relations leadership with projects, tasking, research, and the like, as may be assigned.
• May be responsible for assisting in any internal/external audit processes that may touch processes performed by members of the Provider Relations Team as assigned.
APPLICABLE KNOWLEDGE, SKILLS, & ABILITIES (KSA)
• Knowledge of CPT, ICD-10 procedure and diagnosis coding.
• Strong working knowledge of following processes and able to understand necessary level of detail.
• Abilities utilizing problem-solving approach and collaboration for resolution.
• Ability to engage in review of completed tasks performed personally as well as tasks completed by others for quality control and understand when follow up is required.
• Ability to design and analyze data using spreadsheets and databases.
• Knowledge of, ability to interpret, and consistently apply internal/organizational, as well as applicable external/regulatory policies.
• Knowledgeable in methods to maintain accurate records as well as accurate data entry techniques.
• Maintains contemporary knowledge of rules and laws which govern aspects of provider credentialing practices.
• Proven capabilities of working with minimal supervision
• Ability to communicate clearly in written form.
• Interpersonal communication skills and ability to work with others.
• Proven skills with Microsoft Office Suite programs/applications (e.g., Excel, Access, Word, Outlook, etc.); specific skill levels of Basic with Excel including basic formulas, Intermediate with Word, and Basic business level skills with Outlook and Microsoft Teams.
• Skilled with establishing timelines and consistently meeting deadlines.
• Able to select an appropriate method for processing various tasks/workflow items to ensure consistent high levels of accuracy.
QUALIFICATIONS
• Minimum of earned high school Diploma or GED required; relevant work experience may be considered in lieu of diploma.
• Earned Associate degree in Accounting, Business, Healthcare-related field or other similarly focused field of study preferred.
• Minimum of 3 years professional work experience required.
• Prior experience with CPT, ICD-10 procedure and diagnosis coding strongly preferred.
PHYSICAL/MENTAL DEMANDS & WORK ENVIRONMENT While performing the essential duties of this position, an employee will typically experience:
• Standing, walking, and sitting.
• Lifting and/or moving up to 10 pounds; occasionally lifting and/or move up to 25 pounds short distances.
• Usage of close vision, distance vision, and ability to adjust focus.
• Manipulation of keyboards, keypads, and calculators.
• Placing and answering telephone calls.
• Focused task tracking and follow-through.
• Some interpersonal tension in problem-solving/resolution interactions.
• Speaking/presenting to internal and external audiences of diverse sizes.
• Work environment noise level that is usually moderate.
• Open office environment with few, if any, loud sounds, or ongoing auditory distractions.
• Some deadline related stress.
• As needed evening and weekend hours on a periodic basis.
• Minimal travel, typically in-state.
To perform successfully in this position, an individual must be able to perform essential duties satisfactorily as well as possess education/experience, knowledge, skill, and abilities (KSA) as listed in representative fashion; reasonable accommodations may be made to enable individuals with limitations/disabilities to perform the essential functions of this position. The essential duties and KSA listed are not all inclusive, but representative. Other duties may be assigned. Blue Cross Blue Shield of Wyoming is an EOE, M/F/Vet/Disabled employer. Blue Cross Blue Shield of Wyoming uses E-Verify to confirm employment eligibility. Equal Opportunity is the Law EEO is the Law Supplement IER Right to Work FMLA E-Verify Pay Transparency

Job Tags

Full time, Work experience placement, Work at office, Weekend work, Afternoon shift,

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