Credentialing and Contracting Specialist I - Wellmark, Inc.

Why Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputation on 85 years’ worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors–our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today! 

Learn about our unique benefit offerings here. 

Learn about life at Wellmark here.

As a Credentialing and Contracting Specialist I you will support the corporation’s less complex provider enrollment and data information requirements that support the delivery of Wellmark provider networks for group purchasers and Wellmark customers. This includes ensuring providers meet credentialing and contracting criteria and are set up for accurate provider reimbursement for claims adjudication.

Required:

• High School Diploma or GED
• 1+ year of experience working in a fast-paced environment. Health care related workplace such as provider office setting, insurance operations, provider network administration, contracting, credentialing, or similar area is preferred.
• Strong problem solving skills and demonstrated commitment to timeliness, prioritization, accuracy, and attention to detail as it applies to process, guidelines, etc.
• Strong written and verbal communication skills with the ability to clearly and concisely communicate information to stakeholders and respond to providers with a customer service mindset.
• Collaborates with team members to accomplish goals or outcomes. Builds trust and connects with others in order to complete work.
• Ability to adapt to an ever-changing work environment; ability to multitask and manage time.
• Computer literacy – basic computer skills, such as accessing common web and desktop applications, navigating multiple sources of information and familiarity with Microsoft Office products.
• Valid state issued ID (or the ability to obtain one within 30 days of employment) is needed to perform some credentialing functions.

Preferred:

• Experience working in an environment where production and/or quality goals were measured.

a. Conduct provider credentialing, re-credentialing, contracting, maintenance, and payment activities timely, with a focus on less complex processes including individual practitioners processes.

b. Support Wellmark’s focus on the Provider experience by providing first class service and communication with providers regarding credentialing and contracting processes. Organize information for Credentialing Committee action (e.g. Clear Pass, Needs Review) based on NCQA guidelines.

c. As assigned, manage the delegation relationship and contracting and credentialing activities with key provider organizations that perform credentialing and re-credentialing functions on behalf of Wellmark. Focus is on less complex delegate relationships.

d. Maintain provider databases accurately and timely in order to support claims processing, provider data reporting, data transfers to external vendor files and directory publication for all Wellmark networks.

e. Review database maintenance reports designed to identify errors that will impact provider data sent to outside vendors. As needed, make corrections to data and modify data policies, and process steps to eliminate errors.

f. Meet both quality assurance and production metrics established by Network Administration leadership.

g. Review quality assurance feedback and understand nature of feedback to prevent future errors.

h. Collaborate and work as a team to coordinate and integrate responses and actions with other team members as well as across the department and with other internal partners such as Claims or Customer/Provider service.

i. Demonstrate understanding of applicable regulations and guidelines to support compliance with regulatory standards e.g. NCQA and HIPAA. Professionally handle confidential and protected health information.

j. Other duties as assigned.

An Equal Opportunity Employer

The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at careers@wellmark.com

Please inform us if you meet the definition of a "Covered DoD official".