Technical Information Specialist

BlueCross BlueShield of South Carolina • Columbia, SC

9d • Onsite

About The Position

Responsible for the maintenance of records and the processing of claims in medical review along with any and/or all of the following: processes ingoing/outgoing mail and prepares work for nursing staff. Troubleshoots claims prior to nurse review and after review. Monitors timeliness of claims processing and adjusts claims keyed incorrectly. Performs quality control of work processes. Description Logistics: Palmetto GBA - one of BlueCross BlueShield's South Carolina subsidiary companies. Working onsite at 17 Technology Circle, Columbia, SC 29203 or 200 North Dozier Boulevard Florence, SC 29501 Processes denials of claims. Processes adjustment claims for both pre-pay and post-pay departments. Investigates and analyzes adjustment claim history and denial records. Prescreens records for review and maintains accurate records of all claims. Communicates with provider community and assists provider service department in responding to inquiries. Generates educational correspondence to providers regarding denials.

Requirements

• One year administrative/clerical support
• High School diploma
• Working knowledge of word processing software
• Strong analytical, organizational, and customer service skills
• Strong verbal and written communication skills
• Proficiency in spelling, punctuation, and grammar skills
• Good judgment skills
• Ability to handle confidential or sensitive information with discretion
• Microsoft Office

Responsibilities

• Maintenance of records
• Processing of claims in medical review
• Processes ingoing/outgoing mail
• Prepares work for nursing staff
• Troubleshoots claims prior to nurse review and after review
• Monitors timeliness of claims processing
• Adjusts claims keyed incorrectly
• Performs quality control of work processes
• Processes denials of claims
• Processes adjustment claims for both pre-pay and post-pay departments
• Investigates and analyzes adjustment claim history and denial records
• Prescreens records for review
• Maintains accurate records of all claims
• Communicates with provider community
• Assists provider service department in responding to inquiries
• Generates educational correspondence to providers regarding denials

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees