Specialist, Provider File I

001 BlueCross and BlueShield of South Carolina; Myrtle Beach (SC); On-site; USD 42,000 - 55,000; Full time

Benefits offered by this job

Subsidized health plans

Dental and vision coverage

401k retirement savings plan with公司匹配

Life Insurance

Paid Time Off

On-site cafeterias and fitness centers

Job summary

BlueCross BlueShield of South Carolina is seeking a Provider File Specialist I to establish and maintain provider files to support directories, claims adjudication, and provider billing.

The role requires a high school diploma or equivalent, with about one year of administrative support and customer service experience. Proficiency in MS Office and a willingness to learn PIMS are important. Office-based, full-time position located in Myrtle Beach, SC.

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; ability to learn PIMS.

Responsibilities

• Verifies necessary information and establishes certification of healthcare service providers.
• Prepares and maintains provider data in PIMS or provider systems/databases.
• Identifies providers and assigns them to the appropriate network/system.
• Maintains data and runs reports in PIMS/AMMS or provider systems.
• Contributes to special projects such as audits and quality improvement.

Skills

Administrative support

Customer service

Data entry

Office software

Education

High School Diploma or equivalent

Tools

PIMS

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

Provider File Specialist I is 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.

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, regular business hours: 8:00 AM-5:00 PM. This role is located onsite at 8733 Highway 17 Bypass, Myrtle Beach, SC 29575 SCA

Benefit Requirements

BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). As a Service Contract Act (SCA) employee, you are required to enroll in our health insurance, even if you already have other health insurance. Until your enrollment is complete, you will receive supplemental pay for health coverage. Your coverage begins on the first day of the month following 28 days of full-time employment.

Sponsorship

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

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.

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 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.

Required Software and Other Tools

• Microsoft Office

Preferred Skills and Abilities

• Ability to learn DB2, SQL language to create/run PIMS queries for QC/research purposes.

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.

Disclaimer / Additional Information

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