Provider File Specialist I

Overview 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. Location and Logistics 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 8:30 AM–5:00 PM . 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. 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: mass rate updates, quality improvement, audits, etc. Qualifications Required Education: High School Diploma or equivalent Experience: 1 year of administrative/clerical support, customer service, claims processing, and/or provider network/certification experience. Software: Microsoft Office Skills: 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. Preferred Preferred Skills and Abilities: 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. Benefits 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. 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. 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 View email address on click.appcast.io or call View phone number on click.appcast.io 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. Here\'s more information. Some states have required notifications. Here\'s more information. #J-18808-Ljbffr BlueCross BlueShield of South Carolina