Provider Enrollment Specialist

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

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.