NHS Human Services, Inc.

This job was posted by https://www.kansasworks.com : For more information, please see: https://www.kansasworks.com/jobs/13211149

Responsible for the prompt, courteous, accurate and timely enrollment processing for network providers engaging as contracting within all networks within BCBSKS; including recording and tracking contracts in the Provider Network Solutions suite of record systems. Be familiar with BCBSKS contract offerings. Reviews and assesses network enrollment eligibility. Assists providers with questions regarding network contracting and enrollment processes. Serve as internal corporate resource for questions concerning network participation guidelines. Coordinate new enrollment completion with Provider Network Solutions Provider Representatives to engage new providers and complete onboarding experience.

What youll do

• Responds to provider network enrollment inquiries to initiate enrollment onboarding activities.
• Perform research to validate eligibility for BCBSKS contracting and network enrollment. Ensures enrollment eligibility as required by or standard by the Association, CMS, federal, and state legislated guidelines, and/or BCBSKS business needs compliance regulations.
• Complete network enrollment lifecycle activities including initial quality review, validation of required licenses, accreditation compliance, NPI registration, and board certification, record creation and coordination of onboarding completion.

{=html} <!-- --> - Create and maintain provider records in the network management systems to facilitate enrollment and audit documentation review.

{=html} <!-- --> - Educate and assist internal users and consumers of provider network contract and record information. - Responsible for understanding the network contract variables offered and serviced by BCBSKS to ensure application and enrollment to correct networks as contracted. - Complete annual health plan accreditation education / training on job functions included as part of the accreditation standards relative to provider network. Must be able to comply with accreditation standards as required for job functions. - Perform provider record audits as identified projects require. Assist with provider communications as needed.

Knowledge/Skills/Abilities

• Must be able to learn and apply provider network contracting knowledge throughout enrollment processing for BCBSKS owned and serviced contracts.
• Ability to perform detailed research and gather supporting documentation, to provide network contract eligibility recommendations.
• Ability to work well with multiple active work items and adhere to both complimentary and competing service level agreements.

{=html} <!-- --> - Ability to communicate effectively with staff from provider offices, physicians, and all levels of internal staff required.

{=html} <!-- --> - Employ independent and procedural thinking skills to complete records within defined data entry systems. - Understand sequential workflow procedures. - Work with high degree of accuracy to complete enrollment processing within defined quality and compliance standards. - Must comply with corporate information privacy and security standards and guidelines relative to access control. - Proficiency in utilizing a personal computer is required with knowledge of Microsoft Office suite products. Proficiency in use of provider records systems within six months of hire.

{=html} <!-- --> - Must embrace and demonstrate the companys core competencies and values of integrity, dependability, service, growth and progress, and courage.

What you need

• High school graduate or equivalent is required.
• Two years of experience operational experience within BCBSKS t include customer service, claims or membership OR 3 years demonstrated experience working with medical insurance is required.
• Demonstrated verbal and written communication and human relation skills with the ability to interact positively at all levels with internal and external peers.
• Some lifting of moderately heavy items up to 15 pounds relative to any printed procedure or training manuals.
• Position will be PC work up to 90% of the day to include keying, electronic communications, and virtual meeting attendance; phone usage up to 50% of the day.
• For onsite position assignment, sit / stand desk is available.
• For candidates eligible for work from home or hybrid telecommuting status, onsite attendance at our main campus can be requested as a condition of this position at any time. Must be able to travel as requested.

Bonus if you have

• Preferred education or experience in communications, human relations, medical terminology, or contract compliance.