Senior Provider Enrollment Analyst

CGS Administrators, LLC•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 onsite at 26 Century Boulevard, Nashville, TN, 37214. Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. 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: Functions as Team Leader/senior-level Enrollment Analyst. Provides leadership/guidance/direction/training to staff. Distributes work and is available to answer questions from staff. Acts as a resource for staff regarding any escalating issues. Keeps manager informed of any problems/issues that need resolving. Conducts quality reviews of completed work. Ensures that all audits are completed, verified, and closed. Performs analysis of audits to determine areas for training, development, and education. Ensures that quality work instructions/forms/documents are developed/revised as needed. Provides quality service and communicates effectively with external/internal customers in response to inquiries (correspondence, telephone). Obtains information from internal departments, providers, government and/or private agencies, etc. to resolve discrepancies/problems. Interprets various guidelines and provides input to required procedures. Generates and analyzes various provider reports to management. Participates in testing system changes related to provider files. Contributes/participates/completes special projects as assigned.

Requirements

Bachelor’s degree equivalency: 4 years job-related work experience or an associate's degree and 2 years job related work experience.
2 years of provider network enrollment/certification experience.
Working knowledge of word processing, spreadsheet, and database software.
Working knowledge of provider certification process and claims processing operations/systems.
Good judgment skills required.
Effective customer service, organizational, and presentation 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.
In-depth knowledge of pricing methodology and discount programs.
In-depth knowledge of Medicare program instructions/regulations related to provider enrollment/issues.
Microsoft Office.

Responsibilities

Functions as Team Leader/senior-level Enrollment Analyst.
Provides leadership/guidance/direction/training to staff.
Distributes work and is available to answer questions from staff.
Acts as a resource for staff regarding any escalating issues.
Keeps manager informed of any problems/issues that need resolving.
Conducts quality reviews of completed work.
Ensures that all audits are completed, verified, and closed.
Performs analysis of audits to determine areas for training, development, and education.
Ensures that quality work instructions/forms/documents are developed/revised as needed.
Provides quality service and communicates effectively with external/internal customers in response to inquiries (correspondence, telephone).
Obtains information from internal departments, providers, government and/or private agencies, etc. to resolve discrepancies/problems.
Interprets various guidelines and provides input to required procedures.
Generates and analyzes various provider reports to management.
Participates in testing system changes related to provider files.
Contributes/participates/completes special projects as assigned.