Provider Enrollment Analyst- CGS

Provider Enrollment Specialist

Responsible in the provider enrollment process to review, research, analyze, and process provider enrollment applications. Ensures provider file integrity and that suppliers are in compliance with established standards and guidelines.

Logistics : CGS (cgsadmin.com) 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 26 Century Boulevard, Nashville, TN, 37214.

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). As a Service Contract Act (SCA) employee, you are required to enroll in our health insurance, even if you already have other health insurance. Until your enrollment is complete, you will receive supplemental pay for health coverage. Your coverage begins on the first day of the month following 28 days of full-time employment.

What You'll Do :

• May perform any or all of the following in the enrollment of providers : determines the acceptability of provider enrollment applications (which may be used for initial full application, reenrollment, reactivation, change of information); provides in-depth review and verification / validation of provider data; verifies provider data by use of information databases and various organizations / agencies to ensure authenticity; sets up / tests EFT accounts.
• Processes / enters / updates provider data information / applications into appropriate enrollment database used in evaluating / tracking the processing of the application and / or updating of provider directories.
• Provides quality service and communicates effectively with external / internal customers in response to inquiries (correspondence, telephone).
• Obtains information from internal department, providers, government and / or private agencies, etc. to resolve discrepancies / problems.
• Supplies enrollment applications and general information on the enrollment process to interested enrollees.
• Contributes to and participates on special projects related to provider files.
• Assists technical support staff with testing system changes related to provider files.
• Assists with process improvements related to provider enrollment.
• Assists with provider education and provider services training.

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

We Prefer That You Have the Following :

Our Comprehensive Benefits Package Includes The Following :

What We Can Do for You :

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

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.

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 individuals with disabilities and protected 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 disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 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.

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