What are the responsibilities and job description for the Supervisor, Provider File Operations position at Palmetto GBA?
Summary
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
Logistics: Palmetto GBA, 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 17 Technology Circle, Columbia, SC, 29203.
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). Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date.
What You’ll Do
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.
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: (Standard, unless otherwise instructed during intake)
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.
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.
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
Logistics: Palmetto GBA, 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 17 Technology Circle, Columbia, SC, 29203.
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). Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date.
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.
- Required Education: Bachelor's degree in a job-related field. Four (4) years job related work experience or associate's and two (2) years job-related work experience.
- Required Experience: Three (3) years-of provider network experience utilizing integrated computer systems.
- Required Software and tools: Microsoft Office. Knowledge of computer systems support.
- 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.
- 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.
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
- Education Assistance
- Service Recognition
- National discounts to movies, theaters, zoos, theme parks and more
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: (Standard, unless otherwise instructed during intake)
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.
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.
