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Provider Research Specialist

BlueCross BlueShield of Tennessee

Chattanooga, TN(remote)

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JOB DETAILS
SKILLS
Analysis Skills, Auditing, Cactus, Communication Skills, Compensation and Benefits, Contract Creation, Contract Management, Customer Support/Service, Detail Oriented, Health Plan, Healthcare, Healthcare Providers, Interpersonal Skills, Microsoft Excel, Microsoft Office, Microsoft Outlook, Microsoft PowerPoint, Microsoft Product Family, Microsoft Word, Military, Multitasking, Operational Support, Operations Management, Operations Processes, Organizational Skills, Presentation/Verbal Skills, Problem Solving Skills, Provider Contracting, Provider Relations, Reimbursement, Research Contracts, Resume Search, Systems Maintenance, Writing Skills, eCommerce
LOCATION
Chattanooga, TN
POSTED
30+ days ago
Join Our Team as a Provider Research Specialist with Provider Operation Process Support!

Are you passionate about ensuring accuracy and efficiency in healthcare operations? BlueCross BlueShield of Tennessee’s Provider Operation Process Support team is looking for a detail-oriented Research Specialist to join our mission of improving healthcare access and affordability.

In this role, you will:

+ Audit incoming applications to ensure all required information is documented or attached.
+ Handle multiple applications simultaneously with using BPM, Cactus, CAQH, and Facets
+ Communicate effectively with providers and internal teams to resolve any issues and ensure smooth operations.

Preferred skills include:

+ Strong multitasking abilities and proficiency in using multiple applications.
+ Excellent communication skills for interacting with providers and internal teams.
+ Back office or auditing experience.
+ Experience with credentialing software such as Cactus and familiarity with Facets.

If you are a strategic thinker with exceptional analytical skills, we want to hear from you. Help us shape the future of healthcare by enrolling providers to work with BCBST, making a meaningful difference in the lives of our members.

Job Responsibilities

+ Monitors provider system data files and creates and maintains contract fact sheets for each contracted provider, including but not limited to: participation in all BCBST networks, special arrangements, and reimbursement data in all BCBST systems.
+ Works closely with Provider Relations and Provider Service Organization staff to resolve provider and member problems or complaints related to provider participation status.
+ Investigates all information associated with contract(s) to ensure accuracy and completeness (i.e., profile form, change forms, provider leaving group forms, signature pages, reimbursement schedules, escalation, incentive, pre-application information, credentialing information and electronic commerce information).
+ Works closely with the provider community to get corrected data needed from the research of the contracts and forms received prior to having contract data entered and maintained in the FACETS system.

Job Qualifications

_Education_

+ High School Diploma or equivalent

_Experience_

+ 3 years - Experience in a Support function or Customer Service, experience with the military, or coursework towards a related degree.

_SkillsCertifications_

+ Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
+ Proficient oral and written communication skills
+ Proficient interpersonal and organizational skills

This position is a BBNE, Grade 09, Incentive AEP

Must have BCBST Research Specialist experience

Number of Openings Available

1

Worker Type:

Employee

Company:

BCBST BlueCross BlueShield of Tennessee, Inc.

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin,citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices (https://www.bcbst.com/docs/equal-employment-opportunity.pdf)

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health since 1945. More than that, we're your neighbors and friends – fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow.

At BCBST, we empower our employees to thrive both independently and collaboratively, creating a collective impact on the lives of our members. We seek talented individuals who excel in a team environment, share responsibility, and embrace accountability.

We're also seeking candidates who are proficient in the Microsoft Office suite, including Microsoft Teams, organized, and capable of managing multiple assignments or projects simultaneously. Additional, strong interpersonal abilities along with strong oral and written communication skills are important across all roles at BCBST.

BCBST is a remote-first organization with many employees working primarily from their homes. Each position within the company is classified as either fully remote, partially remote, or office based.

BCBST hires employees for remote positions from across the U.S. with the exception of the following states: California, Massachusetts, New Hampshire, New Jersey, and New York. Applicants living in these states may move to an approved state prior to starting a position with BCBST at their own expense.If the position requires the individual to reside in Chattanooga, TN, they may be eligible for relocation assistance.

About the Company

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BlueCross BlueShield of Tennessee