Analyst, Provider Enrollment

BlueCross BlueShield of South Carolina•Columbia, SC

1d•Onsite

About The Position

The Analyst, Provider Enrollment reviews, researches, analyzes, and processes provider enrollment applications, while ensuring provider file integrity and compliance with established standards and guidelines. The role may handle initial applications, reenrollment, reactivation, and changes to provider information. It includes validating provider data, maintaining enrollment records, responding to customer inquiries, resolving discrepancies, and contributing to projects and process improvements related to provider files. This is a full-time, onsite position with Palmetto GBA, a BlueCross BlueShield of South Carolina subsidiary, at 17 Technology Circle, Columbia, South Carolina. The schedule is Monday through Friday, 40 hours per week, with an eight-hour shift during normal business hours of 8:00 a.m. to 5:00 p.m. Occasional overtime may be necessary, and travel between buildings may be required. The position is not eligible for current or future sponsorship. As a Service Contract Act employee, the employee is required to enroll in the company health insurance, even if covered by another plan. Until enrollment is complete, supplemental pay for health coverage is provided. Coverage begins on the first day of the month following 28 days of full-time employment.

Requirements

Bachelor’s degree equivalency: four years of job-related work experience, or an associate degree plus two years of job-related work experience.
Working knowledge of word processing, spreadsheet, and database software.
Good judgment skills.
Effective customer service and organizational skills.
Demonstrated verbal and written communication skills.
Proficiency in spelling, punctuation, and grammar.
Basic business math proficiency.
Analytical or critical-thinking skills.
Ability to handle confidential or sensitive information with discretion.
Knowledge of Microsoft Office.
Ability to work Monday through Friday, 40 hours per week, onsite in a typical office environment; occasional overtime and travel between buildings may be necessary.
Must enroll in company health insurance as a Service Contract Act employee.

Nice To Haves

Bachelor’s degree in business administration or health administration.
In-depth knowledge of the provider certification process, claims processing operations or systems, and pricing methodology and discount programs.
In-depth knowledge of Medicare program instructions and regulations related to provider enrollment or issues.
Effective presentation skills.
Eight years of MAC PE experience.

Responsibilities

Determine whether provider enrollment applications are acceptable, including initial applications, reenrollment, reactivation, and changes of information.
Review and verify provider data in depth.
Validate provider data using information databases and various organizations or agencies to confirm authenticity.
Set up and test EFT accounts.
Enter, process, and update provider data and applications in the appropriate enrollment database for application tracking and provider directory updates.
Provide quality service and communicate effectively with internal and external customers in response to correspondence and telephone inquiries.
Obtain information from internal departments, providers, government agencies, and private agencies to resolve discrepancies or problems.
Provide enrollment applications and general enrollment-process information to interested enrollees.
Contribute to and participate in special projects related to provider files.
Assist technical support staff with testing system changes related to provider files.
Assist with Provider Enrollment process improvements.
Assist with provider education and provider services training.

Benefits

Subsidized health plans
Dental coverage
Vision coverage
401(k) 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
Supplemental pay for health coverage until required health insurance enrollment is complete