Provider File Specialist I

001 BlueCross and BlueShield of South Carolina; Columbia (SC); On-site; USD 36,000 - 48,000; Full time

Benefits offered by this job

Health plans

401k

Life Insurance

Paid Time Off

On-site cafeterias

Education Assistance

Service Recognition

Job summary

BlueCross BlueShield of South Carolina is seeking an administrative professional to establish and maintain certification and provider files supporting provider directories and claims adjudication.

You will update provider data in PIMS, assign providers to networks, and support quality improvement projects. Strong MS Office skills and ability to handle sensitive information are required.

This full-time role is based in Columbia, SC, with typical hours 8-5, Monday through Friday.

Qualifications

• High School Diploma or equivalent required.
• 1 year of admin/clerical support, customer service, claims processing, and/or provider network/certification experience.
• Proficient with Microsoft Office; ability to learn PIMS and other provider systems.

Responsibilities

• Verifies information to establish certification of healthcare providers.
• Maintains provider files and data on the provider information management system (PIMS).
• Identifies providers and assigns them to networks.
• Contributes to production standards by maintaining PIMS/AMMS data and generating reports.
• Participates in special projects such as mass rate updates, quality improvement, or audits.

Skills

Administrative support

Customer service

Data entry

Communication

Discretion

Education

High School Diploma or equivalent

Tools

PIMS

AMMS

Job description

Summary

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.

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 8:00 AM-5:00 PM. 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.

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
• Degree Equivalency
• 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 Skills and Abilities

• 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.

Our Comprehensive Benefits Package Includes The Following

• 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 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.

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 individuals with disabilities and protected 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 disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email [e-mail] or call 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. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Veterans Welcome

BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty.