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SalarySummary
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
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!
Logistics:
This is a full-time position (40-hours/week) Monday-Friday 8:00am – 5:00pm working on-site at 26 Century Blvd., Nashville, TN. Highly qualified candidates in Columbia, SC will also be considered.
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.
- Participates in system design, fulfillment of contract requirements, and in ongoing system testing.
To Qualify for This Position, You’ll Need:
- Required Education: Master’s degree from an accredited institution
- Degree Equivalency : Bachelor’s degree with 8+ years of experience in a quality control environment or healthcare regulatory interpretation/application/compliance environment
- Required Work Experience: 5 years of professional experience with a minimum of 4 years in a quality control environment or healthcare regulatory interpretation/application/compliance environment. (Experience in a quality control environment and time spent doing healthcare regulatory interpretation/application/compliance can be combined to meet the four-year threshold for the QA Manager.) OR 3 years-of provider network experience utilizing integrated computer systems.
- 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.
- Required Software and Other Tools: Microsoft Office. Knowledge of computer systems support.
What we Prefer you to have:
- 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 mathematical calculations.
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 your meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. If the qualifications required proof of semester hours, please attach your transcript to your application.
Management will be conducting interviews with the most qualified candidates, with prioritization give 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.
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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.
