Healthcare Provider Enrollement Specialist


Health and Safety

Advert ID




Job Type




Salary Range

Up to USD24.00/hr

No. of Openings


Branch Information

Raleigh - Durham NC Area - (USA) 430 Davis Drive Suite 100 NC Morrisville , NC 27560



Job Description

Compile appropriate information to make requested contractual and demographic updates and changes related to provider data in the

systems of record in an accurate, complete and timely manner. Manage and sustain positive provider relationships. Configure providers

and networks in systems of record, assign provider numbers and communicate with provider community. Facilitate accurate financial claims

payment and provider directory processes. Represent BCBSNC to external provider communities and internal stakeholder groups.

Job Description: * Accurately complete provider enrollment, terminations, demo changes and contracts in provider systems of record to ensure appropriate claims payment in accordance with contractual language.

* Compile, analyze, and verify the required information for provider enrollment, contracts, and maintenance for completeness and accuracy,

and enter it into the systems of record.

* Communicate, orally and in writing, directly with providers to resolve questions and issues regarding updates and changes in the systems

of record.

* Research, respond to, analyze and resolve complex claims issues related to provider setup and provider eligibility on a daily basis.

* Create resolution documents to address provider issues and increase provider satisfaction. Utilize probing and problem solving methods to

resolve all inquiries/requests. Identify, understand and anticipate providers' unexpressed needs and concerns.

* Provide cross functional support and serve as Subject Matter Experts (SMEs) or second tier resolution to internal and external provider

teams (i.e., PSA team, Credentialing, Contracting, Provider Service Consultants, etc).

* Manage timely responses to external provider inquiries and requests. Evaluate new service requests from providers to determine

appropriate actions for recording into the systems of record.

* Perform gap analysis on requests and follows through with communication and/or education to providers on internal BCBSNC process and


* Recommend, and participate in process improvement opportunities for PRiMO Operations. Identify system problems, gaps

or inconsistencies in workflows and/or processes. Recommend appropriate updates, alternatives and solutions.

Hiring Requirements

* Associates/Bachelor's degree or certification in business or health related field with demonstration of strong analytical skills in business, systems or information

management (can be through coursework, internships or relevant work experience).

* MS Office knowledge required

* Ability to adapt to changes quickly

* Is able to work in a high production environment

* Time Management and Strong Organization skills

* Team Mentality

* Person must be very analytical, good to have provider data knowledge, previous extensive claim background, or a customer service background.

* Data entry is involved in this position BUT this is not a data entry position.

* 100% onsite

*contract can go through 2018 and possible extension up to 24 years pending performance.

2 hour onsite interviews with 3 team members members