Provider File Specialist I

BlueCross BlueShield of South Carolina•Myrtle Beach, SC

1d•Onsite

About The Position

The Provider File Specialist I establishes and maintains healthcare provider certification and provider files to support provider directories, accurate and timely claims adjudication, and provider billing. The role verifies provider information received through written notifications, faxes, emails, or telephone contacts; prepares provider files; maintains provider data, including updates, additions, and deletions; and assigns providers to appropriate networks and systems. The specialist also contributes to production standards by working with provider systems and maintenance or error reports, and participates in special projects such as mass rate updates, quality improvement, and audits. This is a full-time, 40-hour-per-week, onsite role at 8733 Highway 17 Bypass in Myrtle Beach, South Carolina. The schedule is Monday through Friday during regular business hours, 8:00 AM to 5:00 PM. The work takes place in a typical office environment and may involve travel between office buildings. The position is subject to Service Contract Act requirements. Employees in this role must enroll in the company health insurance plan, even if they have other coverage. Coverage begins on the first day of the month following 28 days of full-time employment; supplemental pay for health coverage is provided until enrollment is complete. This position is not eligible for current or future sponsorship.

Requirements

High school diploma or equivalent.
At least 1 year of administrative or clerical support, customer service, claims processing, and/or provider network or certification experience.
Working knowledge of word processing and spreadsheet software.
Knowledge of PIMS, or the ability to acquire it.
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.
Microsoft Office skills.

Nice To Haves

Ability to learn DB2 and SQL to create and run PIMS queries for quality-control or research purposes.

Responsibilities

Verify necessary provider information received through written notifications, faxes, emails, or telephone contacts, and/or establish healthcare provider certification.
Prepare provider files and maintain provider data, including updates, additions, and deletions, in PIMS or the appropriate provider system or database.
Identify and assign providers to the appropriate network and provider system or database.
Contribute to departmental production standards by working on PIMS and AMMS, or appropriate provider systems or databases, and by addressing maintenance and error reports.
Contribute to and participate in special projects, including mass rate updates, quality improvement, and audits.