Provider Enrollment Processor

The Provider Operations processer is primarily accountable for validating and entering data information supplied by providers, provider organizations, and internal BCBSMA associates in support of enrollment, credentialing or update of provider information. The position is primarily responsible for ensuring that the practitioner/provider has met all appropriate guidelines including BCBSMA policies and procedures, and adherence to the guidelines and requirements of Massachusetts State Laws, the Center for Medicare Services (CMS), National Committee for Quality Assurance (NCQA) and other governing entries prior to updating data.

This position is eligible for the following personas: Resident, Mobile, and eWorker.

Key Responsibilities:

• Validate and data entry for provider enrollment, credentialing and maintenance related data for practitioners and providers joining the BCBSMA networks and those that are already engaged with BCBSMA using a variety of documentation and system resource including but not limited to: Providerhub, RTMS, NASCO, Salesforce, and Cactus
• Reviews contracts, applications, and other supporting documentation for completeness of practitioner/provider data prior to entry into multiple systems
• Verifies data accuracy through supporting databases and websites including licensing boards, specialty boards, accreditation bureaus, sanction tracking websites and databases, etc.
• Process new and update requests for enrollment, credentialing, and maintenance activity according to established policies, workflows, and guidelines in a timely and accurate manner
• Periodically Responds to both internal and external inquiries about operational activity with innovative and creative solutions that result in increased levels of provider satisfaction
• Identifies documentation, system, and other discrepancies and alerts management of discrepancies
• Coordinates with leaders and other team members to respond to priority requests and escalated provider issues as well as consistently achieve turnaround times and performance goals for quality and productivity
• Proactively shares information with other team members, and works in collaboration towards all departmental, divisional and corporate, goals

Key Requirements:  

• Demonstrated customer-focus and service orientation
• Strong data entry skills and attention to detail
• Holds self-accountable for achieving personal and team goals and improving BCBSMA performance
• Proven ability to navigate in multiple systems simultaneously including Windows based and Web based environments
• Excellent organizational skills and ability to work independently
• Self-motivated, takes initiative and demonstrates the ability to work effectively in a fast-paced environment
• Flexibility, ability to handle fast turnaround time and high volumes as needed
• Personal commitment to high quality performance through integrity, accountability, compassion, and teamwork
• Proficiency in Microsoft Office Suite
• Knowledge of BCBSMA data systems desirable but not required.
• Knowledge of Salesforce/SpringCM desirable but not required.

Education/Relevant Experience:

• HS diploma or equivalent, College degree desirable
• One year of work experience in operations or service environment preferred

#LI-HYBRID

High school degree or equivalent required unless otherwise noted above

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting.  We may ultimately pay more or less than the posted range, and the range may be modified in the future.  An employee’s pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note:  No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that the confidence gap and imposter syndrome can  prevent  amazing candidates coming our way, so please don’t hesitate to apply. We’d love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It’s in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting our Company Culture page. If this sounds like something you’d like to be a part of, we’d love to hear from you. You can also join our Talent Community to stay “in the know” on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.