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
 

Logistics:  Palmetto GBA, 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 at 17 Technology Circle, Columbia, SC, 29203.

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). Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date.

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.
• Supervises/motivates/trains/assist staff with questions.
• Responsible for recruiting and hiring, coaching and mentoring, monitoring and evaluation, and addressing all disciplinary issues in a timely manner.
• Encourage staff in creating and maintaining a work environment with high morale and employee satisfaction through support of professional development, training, career growth, and rewarding high performance.
• Researches and responds to provider related inquiries from internal and external sources.

To Qualify for This Position, You'll Need the Following:

• Required Education: Bachelor's degree in a job-related field. Four (4) years job related work experience or associate's and two (2) years job-related work experience.
• Required Experience: Three (3) years-of provider network experience utilizing integrated computer systems.
• Required Software and tools: Microsoft Office. Knowledge of computer systems support.
• Required Skills and Abilities: 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.

We Prefer That You Have the Following:

• Preferred Work Experience: 5 years-of provider network experience utilizing integrated computer systems.
• Preferred Skills and Abilities: Knowledge of mathematical or statistical concepts. Ability to use complex ma