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!
Description
Position Purpose:
We are currently hiring a Provider File Specialist I to join BlueCross BlueShield of South Carolina. As a Provider File Specialist, you will be responsible for establishing and maintaining certification and/or preparation, reviewing and/or maintenance of healthcare provider files in support of provider directories, accurate/timely claims adjudication, and provider billing.
Location: 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 17 Technology Circle Columbia, SC 29203.
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.
To Qualify for This Position, You’ll Need the Following:
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 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.
We Prefer That You Have the Following:
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:
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…