Summary
 

Why should you join the BlueCross BlueShield of South Carolina family of companies?

Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Position Purpose:

As the Provider Enrollment Director, you will direct the administration of the provider network enrollment including decision making that affects contract performance, budget management, and provider satisfaction. Provides direction/guidance for the completion of all tasks associated with the provider enrollment function while managing the resources to meet all Centers for Medicare and Medicaid Services (CMS) expectations.

Description
 

Logistics:

This is a full-time position working (40-hours/week) Monday-Friday 8:00am – 5:00pm working on-site at 17 Technology Circle Columbia SC, in an office environment with occasional travel to conferences.

What You’ll Do:

• Manages the provider enrollment workload within the approved budget and allocates resources as appropriate in order to meet or exceed CMS defined standards.

• Interacts with internal/external functional areas to develop effective performance measures, goals, and objectives that support the provider enrollment area and are consistent with the needs of the division.

• Analyzes provider enrollment trends to identify specific areas of provider concern.

• Develops plans to mitigate issues while establishing procedures to prevent similar issues from occurring.

• Encourages the staff to improve customer service and expand educational efforts.

• Resolves problems through interaction with multiple areas and varied staff.

• Serves as point of contact for provider/supplier, internal staff, CMS, and other contractors to handle all customer complaints.

• Ensures the appropriate follow through on any possible allegations of fraud received.

To Qualify For This Position, You’ll Need:

• Required Education: Bachelor's degree

• Required Work Experience: 7 years of management experience in healthcare, Medicare, health insurance, or operations OR 7 years of equivalent military experience in grade E4 or above.

What We Prefer You To Have:

• Medicare provider enrollment experience

• Ability to multitask

• PECOS experience

• Exceptional customer service skills

• Strong organizational skills

• Home health/hospice knowledge/experience

• Microsoft Office experience

What We Can Do For You:

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 plan with company match

• Life Insurance

• Paid Time Off (PTO)

• On-site cafeterias and fitness centers in major locations

• Wellness