Specialty Contract Director- Palmetto GBA

Overview

Internal Reference Number: R1046525
Do you have the skills to fill this role Read the complete details below, and make your application today.

Summary

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Position Purpose

Direct operational activities of a national Medicare specialty contract. Oversees multiple functional units (Medical review, Claims, Document Control and Provider Enrollment) performance; workload strategy and adherence to compliance standards to meet the Centers for Medicare and Medicaid services expectations for consistent implementation and application of Medicare policy and coverage guidelines as well as those specific to the administration of the specialty contract according to requirements mandated for all states and territories across the country

Logistics: Palmetto GBA - one of BlueCross BlueShield's South Carolina subsidiary companies.

Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. This role is located at 2743 Perimeter Parkway, Augusta, GA.

What You'll Do

• Directs operational activities of a national Medicare specialty contract. Develops strategy and resultant work plans for the Centers for Medicare & Medicaid Services (CMS) review and approval in response to their requests for consistent implementation of the Medicare specialty contract according to requirements for all states across the country.

• Directs the activities of the contract staff, under CMS' oversight, related to all aspects of contractor and provider requirements. Interacts with CMS central and regional offices, national provider and other associations, state agencies, Medicare contractors, and all other business partners.

• Oversees contract staff and subcontractors.

• Reviews/approves invoices submitted by subcontractors. Approves and submits the monthly invoices and reports submitted to CMS.

To Qualify For This Position, You'll Need The Following

• Required Education: Bachelor\'s in a job-related field.

• Required License/Certification: None.

• Required Experience: 10+ years job related experience to include 4 years of management (or equivalent military experience in grade E4 or above). Workload/workflow management experience.

• Required Skills and Abilities: Excellent verbal and written communication skills. Excellent organizational, customer service and presentation skills. Excellent analytical or critical-thinking skills. Good judgment skills. Proficiency in spelling, punctuation and grammar. Ability to persuade, negotiate with or influence others.

• Required Software and Tools: Microsoft Office.

We Prefer That You Have The Following

• Knowledge of ICD9/CPT4 coding.

• Knowledge of the healthcare delivery system.

• Production management and government operations experience.

• Medicare Part B experience.

• Proficient in Microsoft Excel.

• Project management skills.

Benefits

Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• Subsidized health plans, dental and vision coverage.

• 401k retirement savings plan with company match.

• Life Insurance.

• Paid Time Off (PTO).

• On-site cafeterias and fitness centers in major locations.

• Education Assistance.

• Service Recognition.

• National discounts to movies, theaters, zoos, theme parks and more.

What We Can Do for You

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What To Expect Next

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilitiesand protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email [email protected] or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here\'s more information.

Some states have required notifications. Here\'s more information.

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