Provider File Specialist I

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.
Description
 

This position is located in Myrtle Beach, SC.

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 the 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 in special projects, which may include, but are not limited to, mass rate updates, quality improvement, audits, etc.

• Work environment: Typical office environment. Some travel may be required.

To Qualify for This Position, You’ll Need:

• High School Diploma or equivalent.

• One (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/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.

• Microsoft Office.

We Prefer That You Have:

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

What Blue Can Do For You:

Our comprehensive benefits package includes:

• 401(k) retirement savings plan with company match

• Subsidized health plans and free vision coverage

• Life insurance

• Paid annual leave — the longer you work here, the more you earn

• Nine paid holidays

• On-site cafeterias and fitness centers in major locations

• Wellness programs and a healthy lifestyle premium discount

• Tuition assistance

• Service Recognition

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications.  This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.  Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information. 

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 minorities, females, disabled individuals and 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 physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, 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.