Manager, Enrollment

Palmetto GBA, LLC; Columbia (SC); On-site; USD 75,000 - 95,000; Full time

Benefits offered by this job

Health insurance

401k plan with company match

Life Insurance

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Education assistance

Service recognition

National discounts

Job summary

Palmetto GBA, LLC, located in Columbia, SC, seeks a Provider Enrollment Unit Manager to oversee enrollment staff and ensure timely processing of provider enrollments and related claims. The role emphasizes regulatory compliance, fraud awareness, and performance management within a 40-hour work week onsite.

The position requires a Bachelor's degree, 5 years in healthcare/Medicare operations, and at least 2 years in a leadership role, with strong communication, analytical, and organizational

Qualifications

• A Bachelor's degree in a job-related field is required.
• 5 years of healthcare, Medicare, health insurance operations, or operations experience; 2 years of leadership experience (may be concurrent with the 5 years).
• Excellent verbal and written communication, organizational, and customer service skills.
• Proficiency in spelling, grammar, and punctuation; ability to persuade, negotiate, or influence others.

Responsibilities

• Provides day-to-day management oversight of enrollment staff ensuring accurate and timely completion of provider enrollment and claims administration.
• Manages unit performance to meet productivity, quality, and timeliness standards.
• Ensures compliance with applicable laws and regulations and tracks new requirements.
• Directs analysts to identify potential fraud and pursue investigations.
• Interacts with management to define goals, objectives and performance measures.
• Maintains quality assurance activities and analyzes reports to identify improvement opportunities.
• Collaborates with other departments to implement process and system improvements.
• Prepares and verifies reports as necessary.

Skills

Communication

Organization

Customer service

Presentation

Analytical thinking

Critical thinking

Problem solving

Judgment

Listening

Education

Bachelor's degree

Tools

Microsoft Office

Job description

Summary

Manages the provider enrollment unit ensuring the accurate and timely enrollment of providers, meeting all regulatory requirements, and maintains the national provider file database.

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. This role is located onsite at 17 Technology Circle, Columbia, SC, 29203.

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

What You’ll Do:

• Provides day-to-day management oversight of enrollment staff and activities ensuring the accurate and timely completion of all aspects of the provider enrollment process and claims administration.
• Manages individual and unit performance to ensure productivity, quality, and timeliness standards are met.
• Ensures compliance with all applicable laws and regulations and keeps abreast of new requirements.
• Directs the efforts of the analyst staff to be vigilant in the awareness and identification of potential fraud situations, and in working with and following through on fraud investigations.
• Interacts with management staff to define and revise goals, objectives and performance measures.
• Develops and maintains quality assurance activities. analyzes reports and trends to identify areas to improve efforts through outreach and educational activities.
• Maintains effective working relationships with other internal departments to implement process and system improvements and troubleshoot any issues.
• Prepares and verifies reports as necessary.

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

• Required Education: Bachelors in a job-related field.
• Required Work Experience: 5 years of healthcare, Medicare, health insurance operations, or operations experience; 2 years of leadership experience (may be concurrent with the 5 years)
• Required Skills and Abilities: Excellent verbal and written communication, organizational, customer service skills. Excellent presentation, analytical or critical thinking skills. Excellent problem-solving skills. Good judgment skills. Proficiency in spelling, grammar, and punctuation skills. Ability to persuade, negotiate, or influence others. Ability to handle confidential or sensitive information with discretion. Ability to listen effectively and respond quickly.
• Required Software and Tools: Microsoft Office.

We Prefer That You Have the Following:

• Preferred Education: Bachelor’s degree-in Business Administration, Healthcare Administration or other job-related field.
• Preferred Work Experience: 7 years of healthcare program management or provider network experience. 4 of the 7 must be in supervisory experience OR 4 years of equivalent military experience in grade E4 or above.
• Preferred License and Certificate: Active RN licensure in state hired.

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.

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] or 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.

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