Analyst, Provider Enrollment

BlueCross and BlueShield of South Carolina; Columbia (SC); On-site; USD 45,000 - 60,000; Full time

Benefits offered by this job

Subsidized health plans

401k with company match

Paid Time Off

Job summary

BlueCross and BlueShield of South Carolina, via Palmetto GBA, seeks a provider enrollment specialist to review, research, and process enrollment applications from providers. You will ensure data integrity and compliance with standards, handling inquiries from internal and external customers.

The role requires a Bachelor's equivalency or related experience, strong MS Office skills, and the ability to manage confidential information with discretion.

Qualifications

• Bachelor's degree equivalency or four years of related work experience
• Strong knowledge of word processing, spreadsheets, and databases; basic business math
• Excellent communication and organizational skills; ability to handle sensitive information with discretion

Responsibilities

• Determines acceptability of provider enrollment applications (initial full, reenrollment, reactivation, changes)
• Performs in-depth review and verification of provider data
• Verifies provider data via databases and external sources for authenticity
• Sets up/tests EFT accounts
• Enters/updates provider data in enrollment databases and directories
• Provides quality service and responds to inquiries by phone or mail
• Gathers information from internal departments, providers, and agencies to resolve discrepancies
• Distributes enrollment applications and information on the enrollment process to enrollees
• Participates in special projects related to provider files
• Assists IT with testing system changes affecting provider files
• Contributes to process improvements for Provider Enrollment
• Assists with provider education and training

Skills

Word processing

Spreadsheets

Database software

Customer service

Verbal communication

Analytical thinking

Education

Bachelor's degree equivalency

Associate's degree + 2 years related experience

Tools

Microsoft Office

Job description

Summary

Responsible in the provider enrollment process to review, research, analyze, and process provider enrollment applications. Ensures provider file integrity and that suppliers are in compliance with established standards and guidelines.

Description

Logistics: Palmetto GBA - one of BlueCross BlueShield's South Carolina subsidiary companies.

Location

This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located onsite at 17 Technology Circle, Columbia, SC, 29203.

SCA Benefit Requirements

BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). As a Service Contract Act (SCA) employee, you are required to enroll in our health insurance, even if you already have other health insurance. Until your enrollment is complete, you will receive supplemental pay for health coverage. Your coverage begins on the first day of the month following 28 days of full-time employment.

Sponsorship

This position is not eligible for sponsorship now or in the future.

What You’ll Do

• determines the acceptability of provider enrollment applications (which may be used for initial full application, reenrollment, reactivation, change of information)
• provides in-depth review and verification/validation of provider data
• verifies provider data by use of information databases and various organizations/agencies to ensure authenticity
• sets up/tests EFT accounts
• Processes/enters/updates provider data information/applications into appropriate enrollment database used in evaluating/tracking the processing of the application and/or updating of provider directories
• Provides quality service and communicates effectively with external/internal customers in response to inquiries (correspondence, telephone)
• Obtains information from internal department, providers, government and/or private agencies, etc. to resolve discrepancies/problems
• Supplies enrollment applications and general information on the enrollment process to interested enrollees
• Contributes to and participates on special projects related to provider files
• Assists technical support staff with testing system changes related to provider files
• Assists with process improvements related to Provider Enrollment
• Assists with provider education and provider services training

To Qualify for This Position, You’ll Need the Following

• Required Education: Bachelor's degree equivalency: Four (4) years job-related work experience or associate's and two (2) years job related work experience.
• Required Skills and Abilities: Working knowledge of word processing, spreadsheet, and database software. Good judgment skills required. Effective customer service and organizational skills required. Demonstrated verbal and written communication skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Basic business math proficiency required. Analytical or critical thinking skills required. Ability to handle confidential or sensitive information with discretion.
• Required Software and Tools: Microsoft Office.

We Prefer That You Have the Following

• Preferred Education: Bachelor's degree in business administration or health administration.
• Preferred Skills and Abilities: In-depth knowledge of provider certification process, claims processing operations/systems, and pricing methodology and discount programs. In-depth knowledge of Medicare program instructions/regulations related to provider enrollment/issues. Effective presentation skills. 8 years of MAC PE experience.

Our Comprehensive Benefits Package Includes the Following

• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more

What We Can Do for You

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.