Provider Enrollment Analyst - Palmetto GBA

BlueCross BlueShield of South Carolina•Columbia, SC

5d•Onsite

About The Position

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.

Requirements

Bachelor’s degree equivalency: Four (4) years job-related work experience or associate's and two (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.

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

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.