Credentialing Coordinator

Position Description:

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”

The Credentialing Coordinator is responsible for all reporting and analytical activities within the credentialing department, including developing and managing recurring and ad-hoc reports as requested by management as needed. The position is the primary resource for managing the collection of Credentialing, Provider Data (NCQA Timeliness) and Directory Services (Provider Finder) inventory volumes each month for reporting purposes throughout the organization, including senior management. The position also generates the Credentialing Specialist Productivity and Quality Control Audit statistics each month to management. The Credentialing Coordinator is responsible for providing Provider Maintenance Tool (PBM) Open Inventory statistics to management, as needed. This position requires a thorough knowledge of multiple data repositories and reporting platforms, including Symplr Provider, Facets, Crystal Reports, Tableau, Kofax Power PDF, Microsoft Office Suite, and SharePoint. The Credentialing Coordinator must demonstrate the ability to design, develop, and deliver complex, inter-related reports, scorecards, process flows, etc. accurately and timely. Serve as a problem solver for multiple applications (MS-Excel, Crystal Reports, SharePoint, -Symplr Provider, etc.) or business processes with the ability to translate that expertise into actionable work products. Manage all necessary Access Coordinator requests for Credentialing, Provider Data and Directory Services within a timely manner. The position requires the individual should possess detail oriented abilities to multitask, be able to work independently and as a team, demonstrate ability to effectively communicate both verbally and written, demonstrate research and analytical skills, be able to maintain focus for long periods of time, Advanced Excel skills, and Intermediate/Advanced programming/query writing. Develop a solid base of functional expertise of NCQA Standards.

Responsibilities and Qualifications:

Duties and Responsibilities:

85% - Oversight of Credentialing/Recredentialing Reporting & Analytical Functions Develop and provide necessary credentialing/recredentialing, provider, claims, etc. reports to management as needed. Conduct all Delegate duties including File Audits, generate the Credentialing Specialist Productivity statistics each month. Audit the Quality Control reporting for productivity-based activities to ensure singular issues are identified quickly and addressed before system issues lead to broad issues. Provide Provider Maintenance Tool (PBM) Open Inventory statistics to management, as needed. Develop and maintain timely reporting and analytical process to support regulatory reporting and audit requirements to DOH, CMS, NCQA and others. Responsible for managing all ad-hoc reporting requests that are received by the department from within Capital, including from senior management and providing reports back in an expedited manner without impacting standard reporting deliverables by the department. Create, maintain and provide Symplr Provider queries as needed for management. Demonstrates the ability to design, develop, and deliver complex, inter-related reports, scorecards, process flows, etc. accurately and timely. Serve as a problem solver for multiple applications (MS-Excel, SharePoint, Symplr Provider, etc.) or business processes with the ability to translate that expertise into actionable work products. Create Group Recredentialing list using Symplr Provider queries. From Recredentialing list, create roster and upload to CAQH (Proview) for upcoming Recredentialing providers. Develop and maintain the Credentialing, Provider Data and Directory Services SharePoint site. Maintain integrity of provider data through ongoing monitoring and updates to provider information in the provider credentialing software.Develop a solid base of functional expertise of NCQA Standards Schedules and attends training as necessary in FACETS, Symplr Provider, Excel, SharePoint, and CBC applications/systems, as well as take active steps to learn new processes, applications and techniques in support of assigned activities.

15% - Optimize Operational Performance and Improvement in the Credentialing Unit Identify and report deficiencies/concerns immediately to management to support efforts to grow the processes as it relates to efficiency, accuracy and awareness of regulatory and accreditation requirements. Recommend quality improvements to enhance workflow and to increase overall performance and increase efficiencies. Participate in work groups and activities when issues are identified with workflow, to analyze and provide feedback to management. Participate in PMO projects to develop efficient ways to receive and process provider requests in Symplr Provider and Facets. Applies knowledge of Facets, Symplr Provider, Crystal Reports, Excel, SharePoint, and other CBC applications/systems and other resources and information to support all activities including Ad Hoc reporting and projects. Provides support and guidance to department staff at all levels on research and analysis assignments.

Skills:

Detail oriented ability to multitask, be able to work independently and as a team, demonstrate ability to effectively communicate both verbally and written, demonstrate research and analytical skills, be able to maintain focus for long periods of time, Advanced Excel skills. Intermediate programming/query writing.

Knowledge:

Working knowledge of Symplr Provider, Facets, Crystal Reports, Kofax Power PDF, Microsoft Office Suite, SharePoint

Experience:

Minimum of three years’ experience in healthcare, preferably in a related area.

Education and Certifications:

Minimum requirements include high school diploma or GED.

Work Environment:

While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must occasionally lift and/or move up to 5 pounds

About Us:

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a diverse and caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.

And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.

Permanent