Provider File Specialist I

BlueCross BlueShield of South Carolina•Columbia, SC

1d•Onsite

About The Position

BlueCross BlueShield of South Carolina is hiring a Provider File Specialist I to establish and maintain certification and prepare, review, and maintain healthcare provider files. The role supports provider directories, accurate and timely claims adjudication, and provider billing. The position is full-time, 40 hours per week, Monday through Friday, in a typical office environment. The 8-hour shift is scheduled during normal business hours of 8:00 a.m. to 5:00 p.m. Occasional overtime may be necessary, and travel between buildings may be required. The role is onsite at 17 Technology Circle, Columbia, South Carolina 29203. The position is not eligible for sponsorship now or in the future.

Requirements

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

Nice To Haves

Ability to learn DB2 and SQL to create and run PIMS queries for quality control or research purposes.
Strong telephone customer service skills.
Quality and auditing experience.

Responsibilities

Verify necessary information through written notifications, faxes, emails, or telephone contacts and/or establish certification of healthcare service providers.
Prepare provider files and maintain provider data, including updates, additions, and deletions, in PIMS or an 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 system/database maintenance and error reports.
Contribute to and participate in special projects, including mass rate updates, quality improvement, and audits.