Provider File Specialist II

BlueCross BlueShield of South Carolina•Columbia, SC

1d•Onsite

About The Position

Responsible for the maintenance of all provider files through assignment and enrollment on specified provider systems/databases. Responsible for running various queries for reporting on corporate, division, and department levels.

Requirements

High School Diploma or equivalent.
3 years of experience in customer service, claims processing, and/or provider network certification, or combination.
Microsoft Office.
Working knowledge of DB2 or other database software.
Working knowledge of word processing, spreadsheet, and database software.
Knowledge/understanding of PIMS and AMMS.
In-depth knowledge of provider certification process, claims processing operations/systems.
In-depth knowledge of pricing methodology and discount programs.
Good judgment skills.
Demonstrated verbal and written communication skills.
Demonstrated proficiency in spelling, punctuation, and grammar skills.
Basic business math proficiency and knowledge of mathematical or statistical concepts.
Analytical or critical thinking skills.
Ability to handle confidential or sensitive information with discretion.

Responsibilities

Obtains necessary information (written notifications, faxes, emails, or telephone contacts) and 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 systems/database.
Generates and analyzes various provider reports to management.
Assists with providing technical support through system testing to ensure system enhancements/modifications.
Researches/resolves issues/problems from providers related to eligibility, recertifications, edits, billing, etc.
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 the following: mass rate updates, quality improvement, audits, etc.