Specialist, Provider File I

BlueCross BlueShield of South Carolina•Myrtle Beach, SC

6d•Onsite

About The Position

Position Purpose: Provider File Specialist I is 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. Logistics: BlueCross BlueShield of South Carolina - About Us | BlueCross BlueShield of South Carolina Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment, regular business hours: 8:00 AM-5:00 PM. This role is located onsite at 8733 Highway 17 Bypass, Myrtle Beach, SC 29575 SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). As a Service Contract Act (SCA) employee, you are required to enroll in our health insurance, even if you already have other health insurance. Until your enrollment is complete, you will receive supplemental pay for health coverage. Your coverage begins on the first day of the month following 28 days of full-time employment. Sponsorship: This position is not eligible for sponsorship now or in the future.

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.

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.