Processor III Job at Blue Cross Blue Shield of Massachusetts
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The Provider Operations processer is primarily accountable for validating and data entering 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.
Key Responsibilities:
Validate and data enter 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: RTMS, HURN, NASCO, Salesforce, CAQH and CVO
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
Minimum Education Requirements:
High school degree or equivalent required unless otherwise noted above
Location Hingham Time Type Full time
At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. We provide a flexible hybrid work model in which roles are designated as resident (on site 4-5 days/week), mobile (on site 1-3 days/week), or eworker (on site 0-3 days/month).
Blue Cross Blue Shield of Massachusetts, has a COVID-19 vaccination requirement for building entry. Your offer of employment is dependent upon either being fully vaccinated for COVID-19 or an accommodation based on a disability or sincerely held religious belief, practice, or observance by submitting a request to Human Resources.
Please Note :
caminobluff.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, caminobluff.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.
The Provider Operations processer is primarily accountable for validating and data entering 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.
Key Responsibilities:
Validate and data enter 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: RTMS, HURN, NASCO, Salesforce, CAQH and CVO
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
Minimum Education Requirements:
High school degree or equivalent required unless otherwise noted above
Location Hingham Time Type Full time
At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. We provide a flexible hybrid work model in which roles are designated as resident (on site 4-5 days/week), mobile (on site 1-3 days/week), or eworker (on site 0-3 days/month).
Blue Cross Blue Shield of Massachusetts, has a COVID-19 vaccination requirement for building entry. Your offer of employment is dependent upon either being fully vaccinated for COVID-19 or an accommodation based on a disability or sincerely held religious belief, practice, or observance by submitting a request to Human Resources.
Please Note :
caminobluff.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, caminobluff.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.