Summary
 

Supervises provider enrollment and quality assurance staff. Ensures providers are loaded accurately/timely into system, appropriately assigned to networks, and updated correctly when necessary. Manages activities related to the provider file including file maintenance, quality assurance, credentialing, electronic funds transfer payment, provider directories, and applicable contract related requirements.

Description
 

What You’ll Do:

• Oversees credentialing.
• Manages updates/maintenance of various other provider databases to ensure accurate reimbursement, network assignment, online and printed directories, and information for marketing disruption and member access studies also.
• Makes recommendations and executes changes to meet work requirements.
• Develops, implements, and completes all inventory, production, error, and tracking reports.
• Researches and responds to provider related inquiries from internal and external sources.
• Participates in system design, fulfillment of contract requirements, and in ongoing system testing.
• Work environment: Typical office environment. Some travel may be required.

                    

To Qualify for This Position, You’ll Need:

• Bachelor's degree in Business Administration, Information Technology, or other job related field OR Four (4) years of job-related work experience.
• Three (3) years of provider network experience utilizing integrated computer systems. (May be concurrent)
• Excellent verbal and written communication skills.
• Excellent organizational, customer service, and presentation skills.
• Excellent analytical or critical thinking skills.
• Good judgment skills.
• Proficiency in spelling, grammar, and punctuation.
• Ability to persuade, negotiate, or influence others.
• Ability to handle confidential or sensitive information with discretion.
• Knowledge of provider credentialing process.
• Microsoft Office.
• Knowledge of computer systems support

We Prefer That You Have:

• Five (5) years of Provider Network experience utilizing integrated computer systems.
• Knowledge of mathematical or statistical concepts.
• Ability to use complex mathematical calculations.

What Blue Can Do For You:

Our comprehensive benefits package includes:

• 401(k) retirement savings plan with company match
• Subsidized health plans and free vision coverage
• Life insurance
• Paid annual leave — the longer you work here, the more you earn
• Nine paid holidays
• On-site cafeterias and fitness centers in major locations
• Wellness programs and a healthy lifestyle premium discount
• Tuition assistance
• Service recognition

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications.  This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.  Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

 

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

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Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.