Provider Enrollment Analyst

About This Role

This role is responsible for reviewing, researching, analyzing, and processing provider enrollment applications to ensure compliance with established standards and guidelines. The analyst maintains provider file integrity within a healthcare services context, working for a subsidiary of BlueCross BlueShield of South Carolina.

Responsibilities

• Determine the acceptability of provider enrollment applications (initial, reenrollment, reactivation, change of information)
• Perform in-depth review and verification/validation of provider data
• Verify provider data using information databases and various organizations/agencies to ensure authenticity
• Set up and test EFT accounts for providers
• Process, enter, and update provider data information/applications into the appropriate enrollment database
• Provide quality service and communicate effectively with external/internal customers in response to inquiries
• Obtain information from internal departments, providers, government, and private agencies to resolve discrepancies/problems
• Supply enrollment applications and general information on the enrollment process to interested enrollees
• Contribute to and participate in special projects related to provider files
• Assist technical support staff with testing system changes related to provider files
• Assist with process improvements related to provider enrollment
• Assist with provider education and provider services training

Requirements

• Working knowledge of word processing, spreadsheet, and database software
• Good judgment skills
• Effective customer service skills
• Organizational skills
• Demonstrated verbal and written communication skills
• Demonstrated proficiency in spelling, punctuation, and grammar skills
• Basic business math proficiency
• Analytical or critical thinking skills
• Ability to handle confidential or sensitive information with discretion

Qualifications

• Bachelor's degree equivalency: 4 years job related work experience or Associate's and 2 years job related work experience.

Nice to Have

• Bachelor's degree in Business Administration or Health Administration
• In-depth knowledge of provider certification process
• In-depth knowledge of 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

Skills

* Required skills

Benefits