Blue Cross Blue Shield of Massachusetts Provider Operations Senior Processor in Hingham, Massachusetts
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The Directory Accuracy Sr Processer is primarily accountable for the validation and data entering of information received by providers, provider organizations, and internal BCBSMA business partners in support of enrollment/credentialing, maintenance (including contractual) and updates to existing provider information on a multitude of systems. This processor also serves as a point of contact for internal business areas and is responsible for identifying and providing resolution for provider data related issues
Validate and update provider data as received through attested records and maintenance (including contractual) for providers in the BCBSMA networks using a variety of documentation and systems including but not limited to: HURN, RTMS, NASCO, Vital, Salesforce, CAQH and Cactus
Reviews contracts, applications, and other supporting documentation for completeness and accuracy of /provider data prior to updates in multiple systems for downstream display in Provider Directories
Verifies data accuracy through supporting databases and websites
Process new and update attestations for 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 accuracy and data integrity
Proactively identify and recognize trends and behaviors
Collaborate with business partners to identify process improvement and Directory team efficiencies for implementation
Responsible for providing subsequent resolution for provider related issues
Uses solid judgement to identify 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
Strong research skills and attention to detail
Proven problem solver who can work under their own initiative with the ability to work assignments through resolution
Demonstrated customer-focus and service orientation
Demonstrated knowledge of AQC, MSA and Boiler plate agreements
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
Proficient in one or more of the following applications: HURN, RTMS, NASCO, Vital, Directory Blue, Salesforce and Cactus, preferred
HS diploma or equivalent, College degree desirable
1-2 years of work experience in Provider Operations completing contractual maintenance
Proficiency in Microsoft Office Suite, particularly MS Access a plus
Understanding of the enrollment and credentialing process, including licensing boards, specialty boards, accreditation, and affiliations
LocationHinghamTime TypeFull time
Voted as the highest in member satisfaction among Massachusetts commercial health plans by JD Power, Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We have been a market leader for over 75 years, and are consistently ranked among the nation's best health plans. Our daily efforts are dedicated to effectively serving our 2.8 million members, and consistently offering security, stability, and peace of mind to both our members and associates.
Our Commitment to You
We are committed to investing in your development and providing the necessary resources to enable your success. We are dedicated to creating a refreshing and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path. We take pride in our diverse, community-centric, wellness-focused culture and believe every member of our team deserves to enjoy a positive work-life balance.
Blue Cross Blue Shield of Massachusetts is an Equal Employment / Affirmative Action Employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or expression, or any other characteristics protected by law.
Blue Cross Blue Shield of Massachusetts will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with Blue Cross Blue Shield of Massachusetts's legal duty to furnish information.