Provider Enrollment Analyst

BlueCross BlueShield of South Carolina•Nashville, TN

5d•Onsite

About The Position

Logistics: CGS (cgsadmin.com) – one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located at 26 Century Boulevard, Nashville, TN, 37214. 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. 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.

Requirements

Bachelor's degree equivalency: 4 years job related work experience or Associate's and 2 years job related work experience
Microsoft Office
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

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