Summary
 

Manages the provider enrollment unit ensuring the accurate and timely enrollment of providers, meeting all regulatory requirements, and maintains the national provider file database.

Description
 

What You’ll Do:

• Provides day-to-day management oversight of enrollment staff and activities ensuring the accurate and timely completion of all aspects of the provider enrollment process and claims administration.
• Manages individual and unit performance to ensure productivity, quality, and timeliness standards are met.
• Ensures compliance with all applicable laws and regulations and keeps abreast of new requirements.
• Directs the efforts of the analyst staff to be vigilant in the awareness and identification of potential fraud situations, and in working with and following through on fraud investigations.
• Interacts with management staff to define and revise goals, objectives, and performance measures.
• Develops and maintains quality assurance activities. analyzes reports and trends to identify areas to improve efforts through outreach and educational activities.
• Maintains effective working relationships with other internal departments to implement process and system improvements and troubleshoot any issues.
• Prepares and verifies reports as necessary.
• Work environment is the typical office environment may involve minimal travel.
• Position is located onsite, Nashville, TN.

                      

To Qualify for This Position, You’ll Need:

• Bachelor's degree in Business Administration, Healthcare Administration or other job related field.
• Five (5) years of healthcare, Medicare, health insurance operations, or operations experience. Two (2) years of leadership experience (may be concurrent with the Five (5) years).
• Excellent verbal and written communication, organizational, customer service skills.
• Excellent presentation, analytical or critical thinking skills.
• Excellent problem solving skills.
• Good judgment skills.
• Proficiency in spelling, grammar, and punctuation skills.
• Ability to persuade, negotiate, or influence others.
• Ability to handle confidential or sensitive information with discretion.
• Ability to listen effectively and respond quickly.

• Microsoft Office.

We Prefer That You Have:

• Seven (7) years of healthcare program management or provider network experience. Four (4) of the Seven (7) must be in supervisory experience OR Four (4) years of equivalent military experience in grade E4 or above.

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.