Principal Provider Credentialing & Eligibility Delegation
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Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
About Blue Cross and Blue Shield of Minnesota
At Blue Cross and Blue Shield of Minnesota we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate you are joining a culture that is built on values of succeeding together finding a better way and doing the right thing. If you are ready to make a difference join us.
The Impact You Will Have
This position is responsible for managing and enhancing the business relationship between Blue Cross and our delegated providers. This includes performing consistently in the areas of delegated contract implementation and maintenance investigating and researching complex practitioner and provider credentialing and eligibility issues to assure that practitioners and providers comply contract addition the position must have the ability to build and maintain relationships with internal stakeholders clinicians regulatory agencies and others.
*Please note this role is remote but preference will be given to MN residents*
Your Responsibilities
Maintain current compliance Delegation Agreement in coordination with Legal and corresponding delegation oversight tools.
Negotiate and execute Delegation Agreements with contracted entities.
Complete pre-delegation assessments of contracted entities to ensure they meet Blue Cross Blue Shield of Minnesota standards.
Complete ongoing monitoring of semi-annual reports from delegates to meet NCQA standard.
Conduct annual evaluations of delegates as required by the Minnesota Shared Delegation Oversight Collaborative.
Prepare delegation reports and present to Credentialing Committee.
Follow up and manage compliance with all delegates improvement action plans.
Participate in the Minnesota Shared Delegation Oversight Collaborative.
Participate in customer regulatory and accreditation audits along with securing delegate files for review of compliance.
Initiate and lead projects of high complexity to ensure compliance with contracts community standards other credentialing components and/or accreditation/regulatory requirements.
Required Skills and Experience
5 years of related professional experience. All relevant experience including work education transferable skills and military experience will be considered.
3 years of experience working with regulatory and accreditation compliance specifically NCQA.
Proficient skill in working with Microsoft Office products including: Word Excel Access and PowerPoint.
Ability to work independently and demonstrate high degree of problem-solving skills.
Ability to work in collaboration with the credentialing community.
Understanding contract language.
High school diploma (or equivalency) and legal authorization to work in the U.S.
Preferred Skills and Experience
Bachelors degree.
Experience working with credentialing systems.
CPCS certification
Role Designation
TeleworkerRole designation definition: Teleworking is working full time remote. Hybrid is a minimum of 2 days onsite. Onsite is full-time onsite.
Compensation and Benefits
$79100.00 - $104800.00 - $130500.00 AnnualPay is based on several factors which vary based on position including skills ability and knowledge the selected individual is bringing to the specific job.
We offer a comprehensive benefits package which may include:
Medical dental and vision insurance
Life insurance
401k
Paid Time Off (PTO)
Volunteer Paid Time Off (VPTO)
And more
To discover more about what we have to offer please review our benefits page.
Equal Employment Opportunity Statement
At Blue Cross and Blue Shield of Minnesota we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to and will not be discriminated against based on any legally protected characteristic.
Individuals with a disability who need a reasonable accommodation in order to apply please contact us at:
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
Required Experience:
Staff IC
Key Skills
- Business Development
- Classroom Experience
- Dayforce
- Go
- Cloud Computing
- AWS
- Teaching
- Administrative Experience
- Leadership Experience
- negotiation
- SAS
- Data Analysis Skills
