Principal Provider Credentialing & Eligibility Delegation

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 requirements. In 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

• Bachelor's degree.

• Experience working with credentialing systems.

• CPCS certification

Compensation and Benefits:

Pay Range: $79,100.00 - $104,800.00 - $130,500.00 Annual

Pay 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.