Provider Enrollment Analyst - Palmetto GBA

Palmetto GBA•Columbia, SC

6d•Onsite

About The Position

Logistics: Palmetto GBA – 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 onsite at 17 Technology Circle, Columbia, SC, 29203 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). Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date. 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: 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