Provider Research Analyst

Join Our Team as a Provider Research Analyst with Provider Network Operation Credentialing/Compliance!

Are you passionate about ensuring accuracy and efficiency in healthcare operations? BlueCross BlueShield of Tennessee’s Provider Network Operation Quality Assurance/Provider Integrity team is looking for a detail-oriented analyst to join our mission of improving healthcare access and affordability.

In this role, you will:

• Work independently to coordinate regulatory provider compliance audit as assigned by leadership
• Coordinate multiple “Requests for Information (RFIs)” from TennCare, BCBSA, CMS and Internal Audit etc. with competing deadlines
• Communicate effectively with providers and internal teams to resolve any issues and ensure smooth operations.

Preferred skills and experience include:

• Strong multitasking abilities and proficiency in using multiple applications.
• Excellent communication skills for interacting with providers and internal teams.
• Regulatory provider integrity audit experience.
• Experience with claims adjudication system Facets and familiarity with credentialing software Cactus.

If you are a strategic thinker with exceptional analytical skills and a passion to make processes more efficient, we want to hear from you. Help us shape the future of healthcare by ensuring the providers are in good standing with regulatory bodies to participate in BCBST networks, providing peace of mind to our members.

Job Responsibilities

• Providing input internally and in workgroups as to how projects will impact providers, how it will be received, education and communication for implementation and being a functional workgroup participant on implementations.
• Communicates with providers on inquiries, invoices, payments and other day-to-day concerns; addressing issues related to provider enrollment, value based programs and other operational issues.
• Responsible for reviewing and loading non-standard agreement ids that cannot be completed systematically and other complex provider data administration issues.
• Complete testing of all provider related changes in processing applications and vendor services.

Job Qualifications

Education

• Bachelor's Degree or equivalent work experience required. Equivalent experience is defined as 4 years of professional work experience in a corporate environment

Experience

• 1 year relevant experience or experience with the military.

Skills\Certifications

• Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
• Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
• Proven analytical and problem solving skills and ability to perform non-routine analytical tasks
• Must be a team player, be organized and have the ability to handle multiple projects
• Excellent oral and written communication skills
• Strong interpersonal and organizational skills
• In depth knowledge of more than one line of business/systems

Number of Openings Available:

Worker Type:

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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

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.

Tobacco-Free Hiring Statement

To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test.  An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine  and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.

Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.