Provider File Specialist, II

BlueCross BlueShield of South Carolina•Columbia, SC

2d•Onsite

About The Position

The Provider File Specialist is responsible for maintaining provider files through provider assignment and enrollment in specified provider systems and databases. The position also runs queries and generates reports for corporate, division, and department use. This is a full-time, onsite position at 17 Technology Circle in Columbia, South Carolina. The schedule is Monday through Friday, 40 hours per week, working an eight-hour shift during normal business hours of 7:30 a.m. to 5:00 p.m. Occasional overtime may be necessary, and travel between buildings may be required. The role is not eligible for sponsorship now or in the future.

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 and 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 provider certification processes 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 information through written notifications, faxes, emails, or telephone contacts and establish certification of healthcare service providers.
Prepare and maintain provider files and data, including updates, additions, and deletions, in PIMS or other appropriate provider systems and 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 involving eligibility, recertifications, edits, billing, and related 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, which may include mass rate updates, quality improvement, and audits.