Specialist, Provider File I-2

BlueCross BlueShield of South Carolina•Florence, SC

1d•Onsite

About The Position

Responsible for establishing and maintaining certification and/or preparation, review and/or maintenance of healthcare provider files in support of provider directories, accurate/timely claims adjudication, and provider billing. BlueCross BlueShield of South Carolina has been part of the national landscape for more than seven decades, with roots firmly embedded in the South Carolina community. It is the largest insurance company in South Carolina, a leading administrator of government contracts, and operates one of the most sophisticated data processing centers in the Southeast. The company also has a diverse family of subsidiary companies. This position is full-time (40-hours/week) Monday-Friday in a typical office environment, working an 8-hour shift scheduled during normal business hours of 8:00AM-5:00PM. Occasional overtime may be necessary. Travel between buildings may be required. The role is located onsite at 160 North Dozier Boulevard Florence, SC 29501. This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. As a Service Contract Act (SCA) employee, enrollment in the company's health insurance is required, even if other health insurance is held. Supplemental pay for health coverage will be provided until enrollment is complete, with coverage beginning on the first day of the month following 28 days of full-time employment.

Requirements

High School Diploma or equivalent
1 year of administrative/clerical support, customer service, claims processing, and/or provider network/certification experience.
Working knowledge of word processing and spreadsheet software.
Knowledge/understanding of or ability to acquire 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.
Microsoft Office.

Nice To Haves

Ability to learn DB2, SQL language to create/run PIMS queries for QC/research purposes.
Excellent telephone skills and previous Customer Service experience.

Responsibilities

Verifies necessary/needed information (written notifications, faxes, emails, or telephone contacts) and/or 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 system/database.
Identifies/assigns providers to the appropriate network and provider system/database.
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.