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.

Description
 

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we have been part of the national landscape, 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 that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are committed to the same philosophy, consider joining our team!

Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.

Logistics:

This position is onsite at 17 Technology Circle, Columbia, SC 29203. The hours are 8:00 a.m. – 5:00 p.m. Monday – Friday.

What You'll Do:

• Verify 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.
• Identify/assign providers to the appropriate network and provider system/database.
• Contribute to department's production standard by working on PIMS and AMMS (automated medical management systems) or appropriate provider system/database maintenance/error reports.
• Contribute 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:

• 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.
• Experience with Microsoft Office.

Work Environment:

• Typical office environment.
• May involve travel between office buildings.

What We Prefer:

• Ability to learn DB2, SQL language to create/run PIMS queries for QC/research purposes.
   

What We can Do for You:

• 401(k) retirement savings plan with company match.
• Subsidized health plans and free vision coverage.
• Life insurance.
• Paid annual leave – the longer you work here, the more you earn.
• Nine paid holidays.
• On-site cafeterias and fitness centers in major locations.
• Wellness programs and healthy lifestyle premium discount.
• Tuition assistance.
• Service recognition.
• Incentive Plan.
• Merit Plan.
• Continuing education funds for additional certifications and certification renewal.