Specialist, Provider File I-2

ourhrconnect; Florence (SC); On-site; USD 36,000 - 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

Job summary

BlueCross BlueShield of South Carolina is seeking a detail-oriented professional to establish and maintain certification and provider files to support provider directories, accurate/timely claims adjudication, and provider billing. This full-time onsite role in Florence, SC offers typical 8:00 AM–5:00 PM hours, occasional overtime, and potential travel between buildings.

You will work at 200 North Dozier Boulevard, Florence, within a comprehensive benefits package and opportunities to contribute

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; knowledge of PIMS; good judgment; strong verbal and written communication; basic business math; ability to handle confidential information.

Responsibilities

• Verifies necessary information and establishes certification of healthcare service providers; prepares and maintains provider files in the provider information management system (PIMS) or appropriate system.
• Identifies/assigns providers to the appropriate network and provider system/database.
• Maintains data on PIMS/AMMS or provider system; supports reports and audits.
• Participates in special projects such as mass rate updates and quality improvement initiatives.

Skills

Customer service

Data entry

Communication

Attention to confidentiality

Education

High School Diploma

Tools

Microsoft Office

PIMS

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. If you are dedicated to the same philosophy, consider joining our team!

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

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 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 200 North Dozier Boulevard Florence, SC 29501.

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.

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
• Required Work 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 Tools: Microsoft Office.
• Work Environment: Typical office environment. May involve travel between office buildings.

We Prefer That You Have the Following:

• Preferred Skills and Abilities: Ability to learn DB2, SQL language to create/run PIMS queries for QC/research purposes. Excellent telephone skills and previous Customer Service experience.

Our Comprehensive Benefits Package Includes The Following:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• 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.

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