Provider Enrollment Processor

Blue Cross Blue Shield of Massachusetts • Hingham, MA

2d • $27 - $32 • Hybrid

About The Position

Ready to help us transform healthcare? Bring your true colors to blue. The Provider Operations processer is primarily accountable for validating and entering data information supplied by providers, provider organizations, and internal BCBSMA associates in support of enrollment, credentialing or update of provider information. The position is primarily responsible for ensuring that the practitioner/provider has met all appropriate guidelines including BCBSMA policies and procedures, and adherence to the guidelines and requirements of Massachusetts State Laws, the Center for Medicare Services (CMS), National Committee for Quality Assurance (NCQA) and other governing entries prior to updating data. This position is eligible for the following personas: Resident, Mobile, and eWorker.

Requirements

• Demonstrated customer-focus and service orientation
• Strong data entry skills and attention to detail
• Holds self-accountable for achieving personal and team goals and improving BCBSMA performance
• Proven ability to navigate in multiple systems simultaneously including Windows based and Web based environments
• Excellent organizational skills and ability to work independently
• Self-motivated, takes initiative and demonstrates the ability to work effectively in a fast-paced environment
• Flexibility, ability to handle fast turnaround time and high volumes as needed
• Personal commitment to high quality performance through integrity, accountability, compassion, and teamwork
• Proficiency in Microsoft Office Suite
• HS diploma or equivalent, College degree desirable
• One year of work experience in operations or service environment preferred

Nice To Haves

• Knowledge of BCBSMA data systems desirable but not required.
• Knowledge of Salesforce/SpringCM desirable but not required.

Responsibilities

• Validate and data entry for provider enrollment, credentialing and maintenance related data for practitioners and providers joining the BCBSMA networks and those that are already engaged with BCBSMA using a variety of documentation and system resource including but not limited to: Providerhub, RTMS, NASCO, Salesforce, and Cactus
• Reviews contracts, applications, and other supporting documentation for completeness of practitioner/provider data prior to entry into multiple systems
• Verifies data accuracy through supporting databases and websites including licensing boards, specialty boards, accreditation bureaus, sanction tracking websites and databases, etc.
• Process new and update requests for enrollment, credentialing, and maintenance activity according to established policies, workflows, and guidelines in a timely and accurate manner
• Periodically Responds to both internal and external inquiries about operational activity with innovative and creative solutions that result in increased levels of provider satisfaction
• Identifies documentation, system, and other discrepancies and alerts management of discrepancies
• Coordinates with leaders and other team members to respond to priority requests and escalated provider issues as well as consistently achieve turnaround times and performance goals for quality and productivity
• Proactively shares information with other team members, and works in collaboration towards all departmental, divisional and corporate, goals

Benefits

• We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED