Provider File Specialist I
BlueCross BlueShield of South Carolina, Florence, SC, United States
Internal Reference Number: R1049461
Summary
Responsible for establishing and maintaining certification and/or preparation, review, and/or maintenance of healthcare provider files in support of provider directories, accurate and timely claims adjudication, and provider billing.
Logistics:
PGBA – one of BlueCross BlueShield’s South Carolina subsidiary companies.
Location
This position is full-time (40 hours per week), Monday–Friday in a typical office environment. Overtime may be required due to business needs. Occasional travel between buildings may be necessary. The role is located onsite at 200 North Dozier Boulevard, Florence, SC 29501.
SCA Benefit Requirements
BlueCross BlueShield of South Carolina and its subsidiaries have contracts with the federal government subject to the Service Contract Act (SCA). As a Service Contract Act employee, you are required to enroll in health insurance. Supplemental pay is provided until enrollment is complete, effective the first day of the month following 28 days of full-time employment.
What You’ll Do
Verify necessary or needed information (written notifications, faxes, emails or telephone contacts) and/or establish certification of healthcare service providers. Prepare and maintain provider data (updates, additions, deletions) in the provider information management system (PIMS) or appropriate provider system/database.
Identify/assign providers to the appropriate network and provider system/database.
Contribute to department production standards by working on PIMS and AMMS (automated medical management systems) or appropriate provider system/database maintenance/error reports.
Participate on special projects, which may include but are not limited to mass rate updates, quality improvement, audits, etc.
Qualifications
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:
Microsoft Office.
Required Skills:
Working knowledge of word processing and spreadsheet software; knowledge of, or ability to acquire, PIMS; good judgment; effective customer service and organizational skills; written and verbal communication skills; basic business math proficiency; ability to handle confidential or sensitive information with discretion.
Preferred Qualifications
Ability to learn DB2, SQL language for creating/running PIMS queries for quality control/research purposes.
Benefits
Subsidized health plans, dental and vision coverage.
401(k) 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.
Equal Employment Opportunity Statement
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote 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. As a federal contractor, we maintain affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. We 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 those accommodations do not impose an undue hardship on the company.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
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Summary
Responsible for establishing and maintaining certification and/or preparation, review, and/or maintenance of healthcare provider files in support of provider directories, accurate and timely claims adjudication, and provider billing.
Logistics:
PGBA – one of BlueCross BlueShield’s South Carolina subsidiary companies.
Location
This position is full-time (40 hours per week), Monday–Friday in a typical office environment. Overtime may be required due to business needs. Occasional travel between buildings may be necessary. The role is located onsite at 200 North Dozier Boulevard, Florence, SC 29501.
SCA Benefit Requirements
BlueCross BlueShield of South Carolina and its subsidiaries have contracts with the federal government subject to the Service Contract Act (SCA). As a Service Contract Act employee, you are required to enroll in health insurance. Supplemental pay is provided until enrollment is complete, effective the first day of the month following 28 days of full-time employment.
What You’ll Do
Verify necessary or needed information (written notifications, faxes, emails or telephone contacts) and/or establish certification of healthcare service providers. Prepare and maintain provider data (updates, additions, deletions) in the provider information management system (PIMS) or appropriate provider system/database.
Identify/assign providers to the appropriate network and provider system/database.
Contribute to department production standards by working on PIMS and AMMS (automated medical management systems) or appropriate provider system/database maintenance/error reports.
Participate on special projects, which may include but are not limited to mass rate updates, quality improvement, audits, etc.
Qualifications
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:
Microsoft Office.
Required Skills:
Working knowledge of word processing and spreadsheet software; knowledge of, or ability to acquire, PIMS; good judgment; effective customer service and organizational skills; written and verbal communication skills; basic business math proficiency; ability to handle confidential or sensitive information with discretion.
Preferred Qualifications
Ability to learn DB2, SQL language for creating/running PIMS queries for quality control/research purposes.
Benefits
Subsidized health plans, dental and vision coverage.
401(k) 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.
Equal Employment Opportunity Statement
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote 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. As a federal contractor, we maintain affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. We 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 those accommodations do not impose an undue hardship on the company.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
#J-18808-Ljbffr