Provider Data & Credentialing Specialist

ourhrconnect; Florence (SC); On-site; USD 36,000 - 48,000; Full time

Benefits offered by this job

Subsidized health plans

401k retirement savings plan with **公司

Life Insurance

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Job summary

BlueCross BlueShield of South Carolina is seeking a detail-oriented professional to establish and maintain certification and provider files to support provider directories, accurate/timely claims adjudication, and provider billing. This full-time onsite role in Florence, SC offers typical 8:00 AM–5:00 PM hours, occasional overtime, and potential travel between buildings.

You will work at 200 North Dozier Boulevard, Florence, within a comprehensive benefits package and opportunities to contribute

Qualifications

• 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 of PIMS; good judgment; strong verbal and written communication; basic business math; ability to handle confidential information.

Responsibilities

• Verifies necessary information and establishes certification of healthcare service providers; prepares and maintains provider files in the provider information management system (PIMS) or appropriate system.
• Identifies/assigns providers to the appropriate network and provider system/database.
• Maintains data on PIMS/AMMS or provider system; supports reports and audits.
• Participates in special projects such as mass rate updates and quality improvement initiatives.

Skills

Customer service

Data entry

Communication

Attention to confidentiality

Education

High School Diploma

Tools

Microsoft Office

PIMS

Job description

BlueCross BlueShield of South Carolina is seeking a detail-oriented professional to establish and maintain certification and provider files to support provider directories, accurate/timely claims adjudication, and provider billing. This full-time onsite role in Florence, SC offers typical 8:00 AM–5:00 PM hours, occasional overtime, and potential travel between buildings.

You will work at 200 North Dozier Boulevard, Florence, within a comprehensive benefits package and opportunities to contribute