Provider File Specialist I

2 weeks ago

Florence, South Carolina, United States BlueCross BlueShield of South Carolina Full time
Summary
As a Provider File Specialist I, you will be 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
Description

Logistics: 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 at 160 Dozier Boulevard, Florence, SC, 29501.

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). Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date.

What You'll Do:
  • 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.
To Qualify for This Position, You'll Need the Following:
  • Required Education: High School Diploma or equivalent.
  • Required Work Experience: 1 year of administrative/clerical support, customer service, claims processing, and/or provider network/certification experience.
  • Required Skills and Abilities: 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.
  • Required Software and Tools: Microsoft Office.
We Prefer That You Have the Following:
  • Preferred Software and Other Tools: Ability to learn DB2, SQL language to create/run PIMS queries for QC/research purposes.
What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

Our comprehensive benefits package includes the following:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.
  • Subsidized health plans, dental and vision coverage.
  • 401k retirement savings plan with company match.
  • Life Insurance.
  • Paid Time Off (PTO).
  • On-site cafeterias and fitness centers in major locations.
  • Education Assistance.
  • Service Recognition.
  • National discounts to movies, theaters, zoos, theme parks and more.
What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail mycareer.help@bcbssc.com or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

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