Specialist, Provider File I

BlueCross BlueShield of South Carolina•Florence, SC

7d•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. Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! 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. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located onsite at 200 North Dozier Boulevard Florence, SC 29501. Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. 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.

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.