BlueCross BlueShield of South Carolina
Location
Nashville, TN | United States
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
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.
- Work environment: Typical office environment.
- This position is full-time (40 hours/week) Monday-Friday and can be located in any of our primary CGS locations including Nashville, (TN) or Columbia, (SC).
To Qualify for This Position, You’ll Need:
- Bachelor's degree OR Four (4) years of job-related work experience OR Associate's and 2 years job related work experience
- 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.
- Microsoft Office.
We Prefer That You Have:
- Experience in Part A and Home Health and Hospice Provider Enrollment.
- 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
What Blue Can Do For You:
Our comprehensive benefits package includes:
- 401(k) retirement savings plan with company match
- Subsidized health plans and free vision coverage
- Life insurance
- Paid annual leave — the longer you work here, the more you earn
- Nine paid holidays
- On-site cafeterias and fitness centers in major locations
- Wellness programs and a healthy lifestyle premium discount
- Tuition assistance
- Service recognition
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. Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
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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 minorities, females, disabled individuals and 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 physical and mental disabilities.
If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, 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.
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