Provider File Specialist, II

001 BlueCross and BlueShield of South Carolina; Columbia (SC); Vor Ort; USD 42.000 - 56.000; Vollzeit

Benefits dieser Stelle

Subsidized health plans

401k retirement savings plan with 회사 매

Life Insurance

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Education Assistance

Service Recognition

National discounts

Zusammenfassung

BlueCross BlueShield of South Carolina is seeking a detail-oriented provider data coordinator to manage provider files, enrollments, and certifications across our provider systems. You will run queries and generate reports for leadership, supporting enterprise and departmental insights.

The role requires strong communication abilities, proficiency with Microsoft Office, and knowledge of PIMS/AMMS. It is an on-site position located in Columbia, SC, with regular daytime hours and some travel

Qualifikationen

• 3 years of experience in customer service, claims processing, and/or provider network certification, or combination
• Working knowledge of PIMS and AMMS
• Knowledge of pricing methodology and discount programs
• Good judgment, verbal and written communication skills
• Basic business math and analytical thinking

Aufgaben

• Obtain information and certify healthcare service providers.
• Maintain provider data in provider information management system (PIMS) or related systems.
• Generate and analyze provider reports for management.
• Provide technical support through system testing and enhancements.
• Research and resolve provider issues related to eligibility, recertifications, edits, billing, etc.
• Contribute to production standards on PIMS/AMMS or related systems.
• Participate in special projects such as mass rate updates, quality improvement, audits.

Kenntnisse

Communication skills

Analytical thinking

Discretion

Ausbildung

High School Diploma or equivalent

Tools

Microsoft Office

DB2

Jobbeschreibung

Summary

Responsible for the maintenance of all provider files through assignment and enrollment on specified provider systems/databases. Responsible for running various queries for reporting on corporate, division, and department levels. 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 - About Us | 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 7:30 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.

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

What You’ll Do:

• Obtains necessary information (written notifications, faxes, emails, or telephone contacts) and 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 systems/database.
• Generates and analyzes various provider reports to management.
• Assists with providing technical support through system testing to ensure system enhancements/modifications.
• Researches/resolves issues/problems from providers related to eligibility, recertifications, edits, billing, etc.
• 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 Experience: 3 years of experience in customer service, claims processing, and/or provider network certification, or combination.
• Required Software and Other Tools: Microsoft Office. Working knowledge of DB2 or other database software.
• Required Skills and Abilities: Working knowledge of word processing, spreadsheet, and database software. Knowledge/understanding of PIMS and AMMS. In-depth knowledge of provider certification process, claims processing operations/systems. In-depth knowledge of pricing methodology and discount programs. Good judgment skills. Demonstrated verbal and written communication skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Basic business math proficiency and knowledge of mathematical or statistical concepts. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion.

Work Environment:

Typical office environment. May involve travel between office buildings.

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.