Analyst, Provider Enrollment

Palmetto GBA; Columbia (SC); On-site; USD 50,000 - 75,000; Full time

Benefits offered by this job

Subsidized health plans

401k retirement savings with company

Life Insurance

PTO

On-site cafeterias and fitness centers

Job summary

Palmetto GBA, LLC in Columbia, SC, seeks a provider enrollment specialist to review and process enrollment applications, ensuring file integrity and compliance with standards. The role involves data verification against databases, updating enrollment systems, and delivering quality service to internal and external customers.

The position is full-time, onsite, with typical hours 8:00 AM–5:00 PM, some overtime, and possible travel between buildings. Benefits begin after 28 days of employment.

Qualifications

• Bachelor’s degree equivalency: 4 years related work experience or an associate’s degree with 2 years related experience.
• Proficient with word processing, spreadsheets, and databases; strong written and verbal communication.
• Ability to handle confidential or sensitive information with discretion.

Responsibilities

• Review and process provider enrollment applications.
• Verify provider data against information databases and external agencies.
• Enter/update provider data in enrollment databases and update directories.
• Provide responsive customer service via correspondence and telephone.
• Support special projects and provider education/training as needed.
• Assist with testing system changes related to provider files.

Skills

Word processing

Spreadsheets

Database software

Customer service

Organizational skills

Verbal and written communication

Spelling, punctuation, grammar

Business math

Analytical thinking

Discretion with confidential info

Education

Bachelor’s degree equivalency

Experience requirements (4 years or 2 years with associate)

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:

• May perform any or all of the following in the enrollment of providers: 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:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• 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.

What To Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilitiesand protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email [e-mail] call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here’s moreinformation.

Some states have required notifications. Here’s more information.