Provider Enrollment Analyst

Summary

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.

CGS () – one of Blue Cross Blue Shield's South Carolina subsidiary companies.

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 position will be located onsite at 26 Century Boulevard, Nashville, TN 37214 or 17 Technology Circle, Columbia, SC 29203.

This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.

Blue Cross Blue Shield 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.

• 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.

• Required
  
  Education:
  
  Bachelor's degree equivalency: 4 years job related work experience or Associate's and 2 years job related work experience.
• Required Software and tools: Microsoft Office.
• Required
  
  Skills and Abilities:
  
  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.

• Preferred Education: Bachelor's degree-in Business Administration or Health Administration.
• Preferred
  
  Skills and Abilities:
  
  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.

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• Subsidized health plans, dental and vision coverage
• 401k retirement savings…