Resp & Qualifications
The purpose of this job description is to perform all mail functions pertaining to the intake and enrollment process, perform updates in the credentialing system based on correspondence received from non-participating and participating practitioners’. Provide responses to internal and external customer service inquiries. Control workflow within the department. Pre-screen and assign credentialing applications and demographic correspondence. Acknowledge and research CAQH applications. Provide administrative support to the team and management within the department.
Under the direction of the Supervisor, this incumbent’s accountabilities include, but are not limited to the following:
1. Reviews and researches the FLEXX, PORTICO, CAQH and Credentialing Inventory System to determine if provider is new or currently exist in the CareFirst network(s). Screens application and analyzes information retrieved from the CAQH and/or PORTICO systems to determine the appropriate coding for the record to be added to the Credentialing Inventory System. Creates new record in Portico and Credentialing Inventory System using the appropriate case types and when necessary assigns case to the appropriate Credentialing Networks Analyst. Prepares provider folder files for new providers, completes routing form and attach to case. Distributes case to designated Credentialing Networks Analyst via Credentialing Inventory System and match cases after the provider file is received.
2. Picks up and delivers cases to/from other areas in the department, handles special requests for Management, Credentialing Coordinator, files needed for internal and external audits, works on special projects, maintain the supply of welcome packet materials, prepares and mails Welcome Packets based on provider type and jurisdiction,, acts as support and/or backup to other Credentialing Networks Support Representatives.
3. Retrieve process and respond to claim routes from NASCO, FACETS, FLEXX, FEP and platform databases. Research Portico and applicable Legacy systems prior to adding a non par record to make certain accurate data elements are added to assist with claims processing and customer service. Process non par routes and correspondence within required timeframes.
4. Respond to all inbound customer service calls and document all calls by creating a PICS record and or update existing PICS record to include documenting the status of the call in the scratch pad. Confirm all calls retrieved from the customer service line and/or departmental mailbox was answered in the required timeframe. Maintains all Excel and ACCESS databases. Makes certain the appropriate notification letters are prepared and mailed to the practice in a timely manner.
5. Update inventory spreadsheet to track and monitor cases in Quality Assurance Team and Delegated and non-Delegated Teams.
Perform other job related duties or special projects as assigned
Required: High school graduate with a minimum of 2-4 years general office experience preferably in a medical or insurance environment. Analytical skills to research and analyze data; handle and file in specified time frame, a high volume of provider files. Must demonstrate attention to detail and be able to work independently while handling large volume of work accurately. Must be able to prioritize work and demonstrate flexibility. The Incumbent will be required as an essential part of this position to bend, stoop. Incumbent is required to make frequent trips throughout the department, collecting and distributing files. Excellent attendance is required.
• Attentive to detail.
• Good written and verbal communication skills
• Excellent interpersonal skills,
• Accurate data entry skills
• Ability to work at fast pace handling high volume of work,
• Ability to quickly learn and retain information, prioritize multiple tasks while remaining focused,
• Ability to accomplish tasks within established time frames.
• Provider file and credentialing knowledge a must.
• Ability to work as a team member and independently
Must be able to effectively work in a fast paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
• PC skills and proficiency in the use of various software programs. ACCESS data base skills a plus.
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 5.1.21
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship