Information Technology Specialist

BlueCross BlueShield of South Carolina•Columbia, SC

1d•Onsite

About The Position

Responsible for the maintenance of records and the processing of claims in medical review along with any and/or all of the following: processes ingoing/outgoing mail and prepares work for nursing staff. Troubleshoots claims prior to nurse review and after review. Monitors timeliness of claims processing and adjusts claims keyed incorrectly. Performs quality control of work processes. 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: Responsible for the maintenance of records and the processing of claims in medical review along with any and/or all of the following: processes ingoing/outgoing mail and prepares work for nursing staff. Troubleshoots claims prior to nurse review and after review. Monitors timeliness of claims processing and adjusts claims keyed incorrectly. Performs quality control of work processes. Logistics: Palmetto GBA – one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full-time (40 hours/week), Monday-Friday, from 8:00 AM to 5:00 PM , and will be onsite at one of the following locations: 2743 Perimeter Pkwy, Augusta, GA 30909; 200 N Dozier Blvd, Florence, SC 29501; or 17 Technology Cir, Columbia, SC 29203. Sponsorship: This position is not eligible for sponsorship now or in the future. What You’ll Do: Processes denials of claims. Processes adjustment claims for both pre-pay and post-pay departments. Investigates and analyzes adjustment claim history and denial records. Prescreens records for review and maintains accurate records of all claims. Communicates with provider community and assists provider service department in responding to inquiries. Generates educational correspondence to providers regarding denials. Performs quality control of work processes. Assists manager with special projects.

Requirements

Associate's Degree
2 years job related work experience
1 year administrative/clerical support.
Working knowledge of word processing software.
Strong analytical, organizational, and customer service skills.
Strong verbal and written communication skills.
Proficiency in spelling, punctuation, and grammar skills.
Good judgment skills.
Ability to handle confidential or sensitive information with discretion.
Microsoft Office.

Responsibilities

Processes denials of claims.
Processes adjustment claims for both pre-pay and post-pay departments.
Investigates and analyzes adjustment claim history and denial records.
Prescreens records for review and maintains accurate records of all claims.
Communicates with provider community and assists provider service department in responding to inquiries.
Generates educational correspondence to providers regarding denials.
Performs quality control of work processes.
Assists manager with special projects.