Specialist, Provider File

Overview

Summary
:
Responsible for establishing and maintaining certification and/or preparation, review and/or maintenance of healthcare provider files in support of provider directories, accurate/timely claims adjudication, and provider billing.

Logistics:
Blue Cross Blue Shield of South Carolina - About Us | Blue Cross Blue Shield of South Carolina

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 8:00 AM - 5:00 PM. It may be necessary, given the business need, to work occasional overtime. You may be required to travel between buildings. This role is located onsite at 200 North Dozier Boulevard Florence, SC 29501.

Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.

• Verifies necessary/needed information (written notifications, faxes, emails, or telephone contacts) and/or establishes certification of healthcare service providers. Prepares provider files/maintains provider data (updates, additions, deletions) on the provider information management system (PIMS) or appropriate provider system/database.
• Identifies/assigns providers to the appropriate network and provider system/database.
• Contributes to department s production standard by working on PIMS and AMMS (automated medical management systems) or appropriate provider system/database maintenance/error reports.
• Contributes to and participates on special projects, which may include but are not limited to: mass rate updates, quality improvement, audits, etc.

• Required
  
  Education:
  
  High School Diploma or equivalent
• Required
  
  Work Experience:
  
  1 year of administrative/clerical support, customer service, claims processing, and/or provider network/certification experience.
• Required
  
  Skills and Abilities:
  
  Working knowledge of word processing and spreadsheet software. Knowledge/understanding of or ability to acquire PIMS. Good judgment skills. Effective customer service and organizational skills. Demonstrated verbal and written communication skills. Basic business math proficiency. Ability to handle confidential or sensitive information with discretion.
• Required Software and Tools: Microsoft Office.
• Work Environment: Typical office environment. May involve travel between office buildings.

• Preferred
  
  Skills and Abilities:
  
  Ability to learn DB2, SQL language to create/run PIMS queries for QC/research purposes. Excellent telephone skills and previous Customer Service experience.

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

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.

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

Blue Cross Blue Shield 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…