Provider Research Specialist

Responsible for the interpretation & analysis of all standard & non-standard contracts. Additional responsibilities include enrollment of all provider types, (professional, medical service suppliers, dental, behavioral health, pharmacy and institutional) into all BCBST networks.

Job Description:

Job Responsibilities

• Monitors provider system data files and creates and maintains contract fact sheets for each contracted provider, including but not limited to: participation in all BCBST networks, special arrangements, and reimbursement data in all BCBST systems.
• Works closely with Provider Relations and Provider Service Organization staff to resolve provider and member problems or complaints related to provider participation status.
• Investigates all information associated with contract(s) to ensure accuracy and completeness (i.e., profile form, change forms, provider leaving group forms, signature pages, reimbursement schedules, escalation, incentive, pre-application information, credentialing information and electronic commerce information).
• Works closely with the provider community to get corrected data needed from the research of the contracts and forms received prior to having contract data entered and maintained in the FACETS system.

Job Qualifications

Education

• High School Diploma or equivalent

Experience

• 3 years - Experience in a Support function or Customer Service required

Skills\Certifications

• Proficient in Microsoft Office (Outlook, Word, Excel and Powerpoint)
• Proficient oral and written communication skills
• Proficient interpersonal and organizational skills

Job Specific Requirements: 

Preferred Skills:

Number of Openings Available:

1

Worker Type:

Employee

Company:

BCBST BlueCross BlueShield of Tennessee, Inc.

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

Tobacco-Free Hiring Statement

To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test.  An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine  and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.

Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.