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:

The Provider Enrollment Manager manages the provider enrollment unit ensuring the accurate and timely enrollment of providers, meeting all regulatory requirements, and maintains the national provider file database.

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:

• Provides day-to-day management oversight of enrollment staff and activities ensuring the accurate and timely completion of all aspects of the provider enrollment process and claims administration.

• Manages individual and unit performance to ensure productivity, quality, and timeliness standards are met.

• Ensures compliance with all applicable laws and regulations and keeps abreast of new requirements.

• Directs the efforts of the analyst staff to be vigilant in the awareness and identification of potential fraud situations, and in working with and following through on fraud investigations.

• Interacts with management staff to define and revise goals, objectives and performance measures.

• Develops and maintains quality assurance activities. analyzes reports and trends to identify areas to improve efforts through outreach and educational activities.

• Maintains effective working relationships with other internal departments to implement process and system improvements and troubleshoot any issues.

• Prepares and verifies reports as necessary.

To Qualify For This Position, You’ll Need:

• Required Education: Bachelor's in a job related field

• Required Work Experience: 5 years of healthcare, Medicare, health insurance operations, or operations experience; 2 years of leadership experience (may be concurrent with the 5 years).

• Required Skills and Abilities:

  • Excellent verbal and written communication, organizational, customer service skills.

  • Excellent presentation, analytical or critical thinking skills.

  • Excellent problem solving skills.

  • Good judgment skills.

  • Proficiency in spelling, grammar, and punctuation skills.

  • Ability to persuade, negotiate, or influence others.

  • Ability to handle confidential or sensitive information with discretion.

  • Ability to listen effectively and respond quickly.

• Required Software and Tools: Microsoft Office.

What We Prefer You To Have:

• Medicare provider enrollment experience

• Ability to multitask

• PECOS experience

• Home health/hospice knowledge/experience

• Bachelor's degree-in Business Administration, Healthcare Administration or other job related field.

• 7 years of healthcare program management or provider network experience. 4 of the 7 must be in supervisory experience OR 4 years of equivalent military experience in grade E4 or above.

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 program and healthy lifestyle premium discount

• Tuition assistance

• Service recognition

• Employee Assistance

• Discounts to movies, theaters, zoos, theme parks and more

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.

Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information.

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 minorities, females, disabled individuals and 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 physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail mycareer.help@bcbssc.com or call 1-800-288-2227, 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.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information.

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 minorities, females, disabled individuals and 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 physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail mycareer.help@bcbssc.com or call 1-800-288-2227, 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.