Provider Enrollment Manager: Lead QA, Compliance & Growth

Palmetto GBA, LLC; Columbia, Northern (SC, KY); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Subsidized health plans

401k with company match

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Job summary

Palmetto GBA, LLC, a BlueCross BlueShield South Carolina subsidiary, seeks a Provider Enrollment Manager to oversee day-to-day enrollment staff, ensuring accurate, timely provider enrollment and claims processing. You will lead performance, ensure regulatory compliance, and drive quality assurance across teams in a full-time, onsite role.

The position requires 5 years in healthcare/insurance operations and 2 years of leadership, with strong communication and analytical skills.

Qualifications

• Bachelor's degree in a job-related field.
• 5 years of healthcare, Medicare, health insurance operations, or operations experience; 2 years of leadership experience.
• Excellent verbal and written communication, organizational, customer service skills.
• Excellent presentation, analytical or critical thinking skills.
• Excellent problem-solving skills.

Responsibilities

• 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.
• Maintains effective working relationships with other internal departments to implement process and system improvements and troubleshoot any issues.
• Prepares and verifies reports as necessary.

Skills

Verbal communication

Written communication

Organizational skills

Customer service

Presentation skills

Analytical thinking

Critical thinking

Problem-solving

Judgment

Spelling/grammar

Persuasion

Discretion with confidential info

Active listening

Negotiation

Education

Bachelor's degree in a related field

Preferred: Bachelor's in Business Administration / Healthcare Administration or related field

Tools

Microsoft Office

Job description

Palmetto GBA, LLC, a BlueCross BlueShield South Carolina subsidiary, seeks a Provider Enrollment Manager to oversee day-to-day enrollment staff, ensuring accurate, timely provider enrollment and claims processing. You will lead performance, ensure regulatory compliance, and drive quality assurance across teams in a full-time, onsite role.

The position requires 5 years in healthcare/insurance operations and 2 years of leadership, with strong communication and analytical skills.