SCA Provider Enrollment Representative Sr (Part B) - Harrisburg, PA - PS30487 at Anthem, Inc.

Posted in Health Care 21 days ago.

This job brought to you by eQuest

Type: Full-Time
Location: Harrisburg, Pennsylvania





Job Description:

Anthem, Inc. is the nation's leading health benefits company serving the needs of approximately 40 million medical members nationwide.

Your Talent. Our Vision. At National Government Services (NGS), an independent subsidiary of Anthem, Inc. and one of the largest Medicare contractors in the country, it’s a powerful combination.  It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care. 

This is an exceptional opportunity to do innovative work that means more to you and those we serve.  

SCA Provider Enrollment (Part B) Rep Sr.

** Candidate will be required to pass a typing test as part of our pre-employment battery **

Location: 2400 Thea Drive, Harrisburg, PA 17110

Pay: $16.09/hour non-negotiable 

Work Schedule:


  • This is an in-office only position. You will not be able to work from home. 

  • Work hours: Start as early as 7:00am working an 8 hour shift 


Responsible for reviewing and processing credentialing applications and supporting documentation for the purpose of enrolling individual physicians and physician groups with payers.

Responsible for accurate and timely processing of Part B provider enrollment applications.

Primary duties may include, but are not limited to:  



  • Interact professionally with providers and staff representatives to provide information on any necessary documentation required for processing.

  • Plan, prioritize, organize and complete work to meet established objectives.

  • Track and follow up with providers for timely return of all required documents and applications.

  • Assists in synchronization of data among multiple claims systems and application of business rules as they apply to each database. 

  • Validates the data to be housed on provider databases and ensuring adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing. 

  • Leads the department in problem identification, analysis, and resolution for multiple system provider database issues.

  • Participates in system testing and analysis in support of new functionality, new system processes, and business rules changes that will impact provider enrollment processes. Ensures accurate entry of data and reporting to CMS.

  • Reviews the agreement between CMS and the FQHC as well as the Health Resources and Services Administration grant for Federal Qualified Health Centers. Maintains an understanding of the CMS directives and follows all processes and procedures in order to maintain the integrity of the program.

  • Assist in the monitoring of associate's workload and overall inventory.

  • Works with the Quality Assurance Unit to ensure that all regulatory requirements have been met.

  • Validates the accuracy of data submitted utilizing various electronic databases.

  • Assists in the operational training and development of associates on all current CMS guidelines and ISO compliant standard operating procedures for the department.

  • Serves as a resource for associates, and as backup to the Lead.

Qualifications:


  • High School diploma or equivalent

  • Proficient computer skills in Microsoft Word, Excel and databases

  • Capable of meeting time-sensitive deadlines and multi-tasking

  • Strong Data entry skills - Candidate will be required to pass a typing test

  • 3-5 years of data entry and provider enrollment experience

  • Ability to work independently and remain on task

  • Strong organization and planning skills       

  • Strong interpersonal and oral communication skills including professional telephone etiquette

  • Intermediate level of research and analytical skills

Preferred Qualifications:


  • BA/BS degree preferred.

  • Experience in Provider Enrollment, Provider Relations, or Credentialing preferred.

  • 855 application processing knowledge- highly preferred

  • Knowledge of CMS (Center for Medicare/Medicaid Services) regulations and guidelines - highly preferred

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.