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Admin/Support Specialist - filing or credentials
Ref No.: 18-05870
Location: Durham, North Carolina
Admin/Support Specialist
6 month contract
Durham, NC


Support the execution of daily operating activities of the business area by performing various support activities as required by the specific business area.

Carries out the time line for credentialing activities of all professional, facility and ancillary providers, verification of communication with external agencies, and review of applications and supporting documentation prior to their review by the Credentialing Committee. Work with internal and external parties via phone and written correspondence to ensure all work is completed timely as required by regulatory agencies

Maintain and update paper and electronic/database files, scan paper records into electronic system and/or convert/compile data for departmental reports.

Responsible for building provider credentials file and making file determinations regarding required credentialing criteria based on general guidelines, ensuring compliance with all internal policies and NCQA, NCDOI and CMS guidelines.

Receives providers' credentialing information and reviews assigned files for completeness and accuracy based on all NC, NCQA, NCDOI and CMS policies and regulations. Initiate contact to providers for any additional supporting documentation or clarification.

Evaluates requests from providers to determine appropriate actions. Manage timely responses to external provider inquiries and requests. Educates providers on internal processes.

Prepares written correspondence to providers regarding status. Assists in researching pended and probated applications and resolving discrepancies.

Updates new information received in the credentialing database. Accurately prepare and image documents in appropriate areas of the credentialing database.

After reviewing credentialing information, determines whether providers meet BCBSNC credentialing requirements. For providers that do not meet plan requirements, submit a detailed written report of the issues for Credentialing Committee review.

Build file documentation and prepares file for intensive Credentialing Committee review.

- Minimum - High School graduate
- Three years experience in working with medical providers or managed care provider networks in the areas of office administration, records or insurance is required.

Must have worked in a healthcare organization/environment.

Additional Education/Experience Preferences
•An undergraduate degree in business or health related field is preferred.
•Knowledge of Power MHS, or Provider Manager Systems.

Soft Skills:

•Demonstrated ability to effectively communicate orally and in writing with both internal and external customers.
•Proven skills required in verbal/written communication, organization, resourcefulness and decision-making.
•Must be detailed oriented, work under deadlines and feel comfortable working in a production-oriented environment
•The ability to work in a team setting.