Implementation Specialist jobs in Fargo, ND

All about us

You likely know us as an insurance company, but that’s just a portion of what we do. Hundreds of thousands of North Dakotans trust us to provide them with personalized service and unmatched access to care. It’s a mission we take seriously.

We also work with entities throughout the state to challenge the cost and complexity of health care in North Dakota. This uncompromising goal requires caring, innovative people who are ready and willing to help create a new level of health and well-being in North Dakota and beyond.

Work environment

This position has the flexibility to be a remote, hybrid or in-office work arrangement. We empower our employees to find a work style that is best for them. Learn more at Life at Blue | BCBSND.

Pay information

Pay Level: 017

FLSA Category: Non-Exempt - Hourly

A day in the life

The Credentialing Specialist is responsible for reviewing, processing prospective applications from Professional Health Care Provider or Institutional/Ancillary Provider following our credentialing and recredentialing policy. This role is also responsible for maintaining provider data management following policy set by and not limited to URAC, Blue Cross Blue Shield Association and credentialing committee requirements.

Your responsibilities will include:

• Performs credentialing, recredentialing or background check verification activities for prospective providers and does this using telephone, email, or appropriate internet sites.
• Documents provider verification in accordance with organizational and accreditation standards.
• Reviews provider applications and managed care guidelines to make sure they are complete and accurate for the enrollment action being taken. Advises, educates, and initiates necessary requests for information from providers regarding the details of what is missing, incorrect or conflicting for the application being processed.
• Utilizes computerized system to complete a variety of enrollment processing functions and handles data entry and research tasks.
• Requests any additional information in order to complete the credentialing/recredentialing processes. Answers questions regarding the application or the eligibility/credentialing status and creates approval notifications to providers as appropriate. Handles inbound phone calls and email correspondence from internal staff, providers, credentialing agents, executive staff or any appropriate parties representing the provider group, in a professional and timely manner.
• Investigates provider files and managed care payment discrepancies and other provider payment issues related to credentialing or data maintenance processes. Performs research designed to resolve claim processing issues by utilizing the appropriate reference materials and systems.
• Performs changes within in the provider data system based on correspondence from the providers office on changes, as a result of terminations reports and/or as a result of monitoring process for active and unrestricted licenses.

What you need to succeed

• High School Diploma or GED
• 2 years of healthcare, insurance or related experience.
• Ability to manage time and resources.
• Flexibility and ability to be adaptable in different situations.
• Attention to the details and ability to think analytically.
• Intermediate communication skills.

Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards

Benefits and perks

• Wellness incentives including well-being lifestyle spending accounts, employee assistance program and employee discounts.
• Encouraged paid time off including paid holidays and flexible holidays to use as you wish.
• 16 hours of paid volunteer time with a $200 donation to a charity of your choice upon completion of all volunteer hours.
• Employee recognition, community initiative events and yearly company outings.
• Workplace flexibility offering different options for working arrangements and the freedom to make time for important commitments.
• Our core benefits include health, dental, vision and life insurance, short-term and long-term disability and paid parental leave.

Equal opportunity employment

Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.

For questions, please email careers@bcbsnd.com.

This job posting will be closed 4/15/2024 at 8:00 a.m. (CT). No further applications will be considered.