Provider File Specialist II | Data Integrity & Reporting

Palmetto GBA, LLC; Columbia, Northern (SC, KY); Hybrid; USD 42,000 - 64,000; Full time

Benefits offered by this job

On-site cafeterias and fitness centers

Education Assistance

Paid Time Off (PTO)

Job summary

Palmetto GBA, LLC is seeking a Provider File Specialist II to maintain provider files and enrollment on provider systems. The role involves data updates, reporting, and supporting system enhancements in a full-time on-site position in Columbia, SC.

Responsibilities include processing provider information, generating management reports, and resolving provider issues related to eligibility and billing. Requires strong communication and confidentiality, with the possibility of occasional overtime

Qualifications

• High School Diploma or equivalent.
• 3 years of experience in customer service, claims processing, and/or provider network certification, or combination.
• Working knowledge of DB2 or other database software.
• Proficiency in word processing, spreadsheet, and database software; knowledge of PIMS and AMMS is a plus.

Responsibilities

• Obtains necessary information and establishes certification of healthcare service providers.
• Maintains provider data on the provider information management system (PIMS) or provider systems.
• Generates and analyzes provider reports for management.
• Provides system testing support for enhancements/modifications.
• Resolves issues from providers related to eligibility, recertifications, billing, etc.

Skills

Word processing

Spreadsheet

Database software

Verbal communication

Written communication

Analytical thinking

Discretion with confidential info

Education

High School Diploma

Tools

DB2

Job description

Palmetto GBA, LLC is seeking a Provider File Specialist II to maintain provider files and enrollment on provider systems. The role involves data updates, reporting, and supporting system enhancements in a full-time on-site position in Columbia, SC.

Responsibilities include processing provider information, generating management reports, and resolving provider issues related to eligibility and billing. Requires strong communication and confidentiality, with the possibility of occasional overtime