Provider File Specialist, II

BlueCross BlueShield of South Carolina•Columbia, SC

1d•Onsite

About The Position

The Provider File Specialist is responsible for maintaining provider files through assignment and enrollment on specified provider systems and databases, as well as running queries and generating reports at the corporate, division, and department levels. This is a full-time, onsite position in a typical office environment at 17 Technology Circle, Columbia, South Carolina. The schedule is Monday through Friday, 40 hours per week, on an eight-hour shift scheduled during normal business hours of 7:30 AM to 5:00 PM. Occasional overtime may be necessary, and travel between buildings may be required. This position is not eligible for sponsorship now or in the future. The role obtains information needed to establish healthcare provider certification, maintains provider records and data, analyzes reports for management, and helps support system testing and issue resolution. The specialist also contributes to department production standards and participates in special projects such as mass rate updates, quality improvement, and audits.

Requirements

High school diploma or equivalent.
Three years of experience in customer service, claims processing, provider network certification, or a combination of these areas.
Microsoft Office skills.
Working knowledge of DB2 or other database software.
Working knowledge of word processing, spreadsheet, and database software.
Knowledge or understanding of PIMS and AMMS.
In-depth knowledge of the provider certification process and claims processing operations or 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.
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

Obtain necessary information through written notifications, faxes, emails, or telephone contacts to establish certification of healthcare service providers.
Prepare provider files and maintain provider data, including updates, additions, and deletions, in PIMS or other appropriate provider systems or databases.
Generate and analyze provider reports for management.
Assist with technical support through system testing to ensure system enhancements and modifications.
Research and resolve provider issues related to eligibility, recertifications, edits, billing, and other matters.
Contribute to department production standards by maintaining PIMS, AMMS, or other appropriate provider systems and databases, including working on maintenance and error reports.
Contribute to and participate in special projects, including mass rate updates, quality improvement, and audits.