Analyst, Provider Enrollment

BlueCross BlueShield of South Carolina•Columbia, SC

2d•Onsite

About The Position

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. Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Description Logistics: Palmetto GBA – one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full-time 8:00AM – 5:00PM (40-hours/week) Monday-Friday in a typical office environment. 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 Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. 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.

Requirements

Bachelor's Degree
4 years 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.
ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.

Nice To Haves

Bachelor's degree-in Business Administration or Health Administration.
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.

Responsibilities

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.