Provider File Specialist I

BlueCross and BlueShield of South Carolina; Columbia (SC); On-site; USD 40,000 - 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

Education Assistance

Service Recognition

National discounts

Job summary

BlueCross BlueShield of South Carolina is hiring a Provider File Specialist I for our Columbia, SC location. The role focuses on establishing and maintaining certification for healthcare providers, updating provider data, and supporting accurate claims adjudication.

You will work with PIMS, coordinate provider networks, and participate in data quality initiatives. The position is full-time, onsite, with potential overtime and occasional travel.

Qualifications

• High School Diploma or equivalent is required.
• 1 year of administrative/clerical support, customer service, claims processing, and/or provider network/certification experience.
• Proficiency with Microsoft Word and Excel; ability to learn PIMS and related systems.

Responsibilities

• Verifies information and establishes certification of healthcare service providers; updates provider files in the provider information management system (PIMS).
• Identifies providers and assigns them to the appropriate network and system/databases.
• Contributes to production standards by working on PIMS and AMMS maintenance and error reports.
• Participates in special projects such as mass rate updates, quality improvement, and audits.

Skills

Verbal and written communication

Customer service

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

Summary

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!

Position Purpose

We are currently hiring a Provider File Specialist I to join BlueCross BlueShield of South Carolina. As a Provider File Specialist, you will be responsible for establishing and maintaining certification and/or preparation, reviewing and/or maintenance of healthcare provider files in support of provider directories, accurate/timely claims adjudication, and provider billing.

Location

BlueCross BlueShield of South Carolina - About Us | BlueCross BlueShield of South Carolina

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 17 Technology Circle Columbia, SC 29203.

Sponsorship

This position is not eligible for sponsorship now or in the future.

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.

Qualifications

Required Education

High School Diploma or equivalent

Required Experience

1 year of administrative/clerical support, customer service, claims processing, and/or provider network/certification experience.

Required Software and Other Tools

Microsoft Office

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.

Preferred Qualifications

• Ability to learn DB2, SQL language to create/run PIMS queries for QC/research purposes.
• Demonstrates strong telephone customer service skills.
• Quality and auditing experience.

Benefits

• 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

Company Culture & Diversity

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.

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 p